Antiplatelet and anticoagulant agents: key differences in mechanisms of action, clinical application, and therapeutic benefit in patients with non-ST-segment-elevation acute coronary syndromes

Jennings, Lisa K.; Saucedo, Jorge

doi:10.1097/hco.0b013e3283021ad9

Cited by 7 publications

(3 citation statements)

References 36 publications

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“…In humans, the PDE3 isoenzyme is mainly found in platelets, vascular smooth muscle, liver, smooth muscle of the airway, T lymphocytes, adipose tissue, and cardiac tissue [8]. The inhibition of PDE3 leads to suppress cAMP degradation with a consequent increase in cAMP in platelets and blood vessels, resulting in inhibition of platelet aggregation and vasodilation, respectively [9,10]. In addition, cilostazol has pleotropic effects, including the improvement of serum lipid profile with lowering triglycerides, the elevation of high‐density lipoprotein cholesterol, and the inhibition of vascular smooth muscle cell growth.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Cilostazol on Uncontrolled Coronary Vasospastic Angina: A Pilot Study

Yoo

Song²,

Lee

et al. 2013

Cardiovascular Therapeutics

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BackgroundAlthough an angina attack by vasospastic angina (VSA) can usually be relieved or controlled with nitrates and calcium channel blockers (CCBs), there are some patients who cannot be controlled even by higher doses and combinations of these drugs. Cilostazol is a selective inhibitor of phosphodiesterase 3 that increases intracellular cyclic adenosine monophosphate (cAMP) contents. A stimulation of cAMP signal transduction increases coronary nitric oxide production. We examined whether cilostazol improved angina symptoms in patients with VSA uncontrolled by conventional treatment.MethodsThis study was conducted in a prospective, multicenter, nonrandomized manner. The subject consisted of 21 patients (13 men, 57 ± 9 year-old) who were diagnosed with VSA and had at least two angina attacks during the past 1 week despite of conventional medications such as CCBs and/or nitrates. They took cilostazol 100 mg twice daily for 2 weeks in addition to the conventional medications. The patients recorded the frequency of angina attack and wrote down the numeric rating scale of a "severity of angina attack" while taking conventional medications and cilostazol for 2 weeks, and also recorded an averaged scale or total number of event during the last week at the time of the assessment. Using the Wilcoxon rank-sum test, we compared the changes in the scores of frequency and severity of angina attack before and after adding cilostazol to the conventional medications.ResultsAfter adding cilostazol to the conventional medications, there were 78.9% relative reduction of the score of angina intensity and 73.5% of angina frequency (P < 0.001). There were four patients (19%) who were forced to stop cilostazol due to headache as an adverse event.ConclusionsCilostazol appears to be an effective therapy in VSA uncontrolled with conventional medical treatment. A further prospective, randomized, placebo-controlled study will be needed to validate this result.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Cilostazol on Uncontrolled Coronary Vasospastic Angina: A Pilot Study

Yoo

Song²,

Lee

et al. 2013

Cardiovascular Therapeutics

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“…Synergistic platelet inhibition through different platelet activation pathways, by clopidogrel and aspirin, represents a key strategy in current ACS treatment. 17…”

Section: Clinical Use In Acsmentioning

confidence: 99%

“…16 Synergistic platelet inhibition through different platelet activation pathways, by clopidogrel and aspirin, represents a key strategy in current ACS treatment. 17 The rationale for the use of clopidogrel in ACS has been assessed in several trials (Table 1). The CAPRIE trial was the first randomised, blinded, international trial designed to assess the relative efficacy of clopidogrel (75 mg once daily) and aspirin (325 mg once daily) in reducing the risk of a composite outcome cluster of ischaemic stroke, myocardial infarction, or vascular death.…”

Section: Clinical Use In Acsmentioning

confidence: 99%

Clopidogrel Bisulfate: A Review of its Use in the Management of Acute Coronary Syndrome

Rossini

Musumeci

Nijaradze

et al. 2009

Clinical Medicine. Therapeutics

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Antiplatelet therapy is the cornerstone in the modern therapy of patients with acute coronary syndromes (ACS), because of the unique role of platelets in coronary thrombosis. Clopidogrel in combination with aspirin is the current “gold standard” for reducing cardiovascular events in such patients, providing a synergistic platelet inhibition through different platelet activation pathways. Clopidogrel is a thienopyridine which inhibits ADP-induced platelet aggregation, with no direct effects on the metabolism of arachidonic acid. Due to a better safety profile with a similar antiplatelet effectiveness, it is preferred to ticlopidine. In patients with ACS without ST segment elevation (NSTEMI), clopidogrel plus aspirin is able to reduce the relative risk of adverse cardiovascular events by 20%, compared with aspirin alone. Clopidogrel plays a key role also in patients undergoing coronary stenting, in order to prevent stent thrombosis. Pretreatment and long-term treatment with clopidogrel reduces by about one-third the risk of cardiovascular death or myocardial infarction in NSTEMI ACS patients undergoing percutaneous coronary angioplasty (PCI). However, a long-term dual antiplatelet therapy is associated with a higher rate of bleeding events. Clinical practice guidelines currently recommend long-term dual antiplatelet therapy with aspirin and clopidogrel in patients with ACS and a pre-treatment with clopidogrel in every patient scheduled for PCI. The concept of clopidogrel resistance and the need for a pretreatment in patients undergoing coronary stent implantation led to the concept that an improved antiplatelet regimen with novel drugs is desirable.

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Antiplatelet and anticoagulant agents for preventing recurrence of peripheral vascular thrombosis in patients with Antiphospholipid syndrome

Islam

Alam

Sasongko

et al. 2016

Cochrane Database of Systematic Reviews

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Antiplatelet and anticoagulant agents: key differences in mechanisms of action, clinical application, and therapeutic benefit in patients with non-ST-segment-elevation acute coronary syndromes

Cited by 7 publications

References 36 publications

Efficacy of Cilostazol on Uncontrolled Coronary Vasospastic Angina: A Pilot Study

Efficacy of Cilostazol on Uncontrolled Coronary Vasospastic Angina: A Pilot Study

Clopidogrel Bisulfate: A Review of its Use in the Management of Acute Coronary Syndrome

Antiplatelet and anticoagulant agents for preventing recurrence of peripheral vascular thrombosis in patients with Antiphospholipid syndrome

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