Antiplatelet and Anticoagulant Therapies in Acute Coronary Syndromes

Hanna, Elias B.; Glancy, D. Luke; Saucedo, Jorge

doi:10.1007/s10557-009-6212-5

Cited by 8 publications

(5 citation statements)

References 71 publications

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“…Overall, there was no benefit of the higher dose of aspirin, compared with the lower dose. In addition, in the whole population, the higher dose clopidogrel regimen was not superior to the conventional dose and cause more bleeding complications [22]. This overall effect of the high clopidogrel dose resulted from a significant decrease in ischemic events (OR for cardiovascular death, myocardial infarction or stroke: 0.85; 95% CI: 0.74-0.99, p=0.036) in patients treated with percutaneous coronary interventions, and an increased risk in patients not undergoing PCI [23].…”

Section: The Need For New Antiplatelet Agentsmentioning

confidence: 89%

Pharmacologic Therapy for Non ST-segment Elevation Acute Coronary Syndromes: Focus on Antithrombotic Therapy

Danchin

Aïssaoui

2010

Cardiovasc Drugs Ther

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Antithrombotic therapy constitutes the basis of the management of acute coronary syndromes. It combines antiplatelet and anticoagulant therapy. Antiplatelet agents should combine aspirin and agents acting through the ADP pathway such as clopidogrel; newer antiplatelet agents such as prasugrel or ticagrelor have superior anti-ischemic efficacy, compared with clopidogrel. Intravenous glycoprotein IIb/IIIa inhibitors may be used in selected patients at high risk undergoing percutaneous coronary interventions. Unfractionated heparin constitutes the reference anticoagulant treatment. Enoxaparin provides slightly better anti-ischemic efficacy. Newer agents, such as bivalirudin or fondaparinux, reduce bleeding complications, with no improvement in anti-ischemic efficacy. The combination of antiplatelet and anticoagulant agents should be chosen according to the patients' characteristics and the management strategy of the acute coronary syndrome.

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Section: The Need For New Antiplatelet Agentsmentioning

confidence: 89%

Pharmacologic Therapy for Non ST-segment Elevation Acute Coronary Syndromes: Focus on Antithrombotic Therapy

Danchin

Aïssaoui

2010

Cardiovasc Drugs Ther

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“…Kadangkala penyumbatan akut ini terjadi karena adanya spasme arteri koroner, emboli, atau vaskulitis. 5 Infarksi miokardium akut elevasi segmen ST (ST-elevation myocardial infarction = STEMI) adalah bagian daripada spektrum sindrom koronari akut (ACS), di mana ACS terdiri dari angina pektoris tidak stabil, STEMI, dan infarksi miokardium ST non-elevasi (NSTEMI). 6 Tujuan utama dari penanganan STEMI adalah memulihkan kembali aliran darah miokardium, untuk menyelamatkan jantung dan menurunkan mortalitas.…”

Section: Pendahuluanunclassified

“…Pemulihan kembali aliran darah pada arteri koroner dilakukan dengan cara Primary Percutaneous Coronary Intervention (PPCI), namun jika fasilitas PPCI belum tersedia, maka reperfusi dapat diberikan terapi fibrinolitik. 5 Antikoagulan adalah terapi yang memainkan peran kunci dalam terapi reperfusi pada pasien STEMI. Penambahan terapi antikoagulan pada pasien STEMI yang menggunakan fibrinolitik dapat mengurangi resiko kematian dan terjadinya infark berulang (recurrent infarction).…”

Section: Pendahuluanunclassified

Gambaran penggunaan antikoagulan pada pasien ST-Elevatıon Myocardıal Infarctıon (STEMI)

Rahmah¹,

Novrianti²,

Syuhada³

2022

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Penyakit jantung koroner merupakan salah satu penyakit penyebab kematian terbanyak. ST-segment elevation myocardial infarction (STEMI) salah satu klasifikasi dari Infark Miokard Akut (IMA). IMA timbul dari kerusakan permanen pada otot jantung karena suplai oksigen yang tidak mencukupi. Adanya IMA dapat merusak fungsi sistol dan diastol, serta menambah kejadian yang tidak diharapkan seperti aritmia pada pasien. Tujuan dari penelitian ini adalah melihat penggunaan antikoagulan pada pasien STEMI yang menggunakan terapi fibrinolitik. Penelitian ini bersifat deskriptif yang dilakukan secara retrospektif dengan melihat catatan medis pasien STEMI yang menjalani rawat inap di RS “X” kota Tarakan periode 2017-2018. Hasil penelitian menunjukan bahwa semua pasien STEMI menerima terapi antikoagulan. Sebanyak 92,31 % menggunakan enoxaparin dan 7,69 % pasien menggunaan fondaparinux dengan karakteristik pasien sebanyak 12 penyakit penyerta. Pemberian antikoagulan pada pasien STEMI membantu menjaga kondisi arteri setelah proses reperfusi ketika telah diberikan fibrinolitik sehingga tidak menyebabkan terjadinya reoklusi.

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“…Nevertheless, issues relating to clopidogrel resistance and the relatively high recurrence rate of ischemic events with this form of dual anti-platelet therapy indicates a need for additional antithrombotic therapy [7,8]. As triple therapy including oral anticoagulation with vitamin K antagonists results in a high risk of bleeding, better and less risky antithrombotic therapies would be welcome.…”

Section: New Options For Anticoagulant Therapy In Non-valvular Atrialmentioning

confidence: 99%

“…The one clear-cut conclusion, to be taken especially from the combination of AVERROES [4] and ARISTOTLE [5] results, is that there is now a strong argument for wider use of anticoagulant therapy in nonvalvular AF, both in patients previously thought to be at insufficient risk of stroke and in those previously denied such therapy because of perceived haemorrhagic risk. 78 Cardiovasc Drugs Ther (2012) 26:77-84Anti-thrombotic therapy in ACS RUBY-1: A randomized, double-blind, placebo-controlled trial of the safety and tolerability of the novel oral factor Xa inhibitor darexaban (YM150) following acute coronary syndrome Background: In the treatment of acute coronary syndromes (ACS) dual anti-platelet therapy (aspirin and clopidogrel) is recommended, and to be continued for a year after the event.Nevertheless, issues relating to clopidogrel resistance and the relatively high recurrence rate of ischemic events with this form of dual anti-platelet therapy indicates a need for additional antithrombotic therapy [7,8]. As triple therapy including oral anticoagulation with vitamin K antagonists results in a high risk of bleeding, better and less risky antithrombotic therapies would be welcome.…”

mentioning

confidence: 99%

Clinical Trials Update Esc Congress 2011

Rosenson¹,

Horowitz²,

Kaski³

et al. 2012

Cardiovasc Drugs Ther

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New options for anticoagulant therapy in non-valvular atrial fibrillation: Data from ARISTOTLE, ROCKET-AF and RE-LYThe role of Vitamin K antagonists such as warfarin as the management of choice for patients with non-valvular atrial fibrillation (AF) at high risk for thrombo-embolism has been central to therapeutics for many years. However, the use of warfarin is associated with the problem of the need for individual effect monitoring, difficulties in achieving good control in some patients, and substantial risk of bleeding and other complications.In recent years two major classes of oral anticoagulants, direct thrombin inhibitors and factor Xa inhibitors, have been the subject of comparative clinical trials against warfarin in patients with non-valvular AF. Prior to the 2011 ESC meeting key published data on these agents could be summarized as follows:-(1) RE-LY trial. This study was a large (n018,113) randomized open-label comparison of two doses of the direct thrombin inhibitor dabigatran (in doses of either 110 or 150 mg BID) against warfarin, with blinded adjudication of end-points [1]. Patients with severely impaired renal function were excluded. The results surprisingly showed substantial differences in efficacy vs haemorrhagic risk according to dabigatran dosage. The primary efficiency end-point of stroke/systemic embolism occurred less frequently in the high-dose dabigatran group than with warfarin therapy, without an excess of major haemorrhagic complications, while the lower (100 mg BID) dabigatran dosage regimen was associated with a significantly lower rate of haemorrhagic complications than that associated with warfarin treatment. Furthermore, both dabigatran regimens were associated with significantly lower rates of intracranial haemorrhage than those occurring with warfarin treatment. Minor concerns were an excess of gastrointestinal tract bleeds and a trend towards an increased rate of acute myocardial infarction. An analysis of the impact of variable warfarin control, as measured by time in the therapeutic range, on the results of RE-LY [2], suggested that these results were large, but not entirely, independent of individual centres' quality of INR control.(2) ROCKET-AF. This study was a double-blind randomized comparison of the Factor Xa inhibitor rivaroxaban against warfarin, conducted in a population of 14,264 relatively high risk patients with non-valvular AF [3]. Importantly, rivaroxaban was given as a once-daily dosage of 20 mg (or 15 mg in patients with moderate impairment of renal function). Patients with CHADS 2 scores of 1 were excluded: 87% of patients had CHADS 2 scores of ≥ 3.The primary end-point of the study (stroke) systemic embolism occurred at a rate of 1.7% per annum on rivaroxaban and 2.2% per annum on warfarin, clearly establishing noninferiority of rivaroxaban. However, this primary analysis was a per-protocol, on-treatment method. While the incidence of intracranial haemorrhage was significantly lower with rivaroxaban therapy, there was no overall reduction in the principal...

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Antiplatelet and Anticoagulant Therapies in Acute Coronary Syndromes

Cited by 8 publications

References 71 publications

Pharmacologic Therapy for Non ST-segment Elevation Acute Coronary Syndromes: Focus on Antithrombotic Therapy

Pharmacologic Therapy for Non ST-segment Elevation Acute Coronary Syndromes: Focus on Antithrombotic Therapy

Gambaran penggunaan antikoagulan pada pasien ST-Elevatıon Myocardıal Infarctıon (STEMI)

Clinical Trials Update Esc Congress 2011

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