Aspirin Discontinuation in Patients Requiring Oral Anticoagulation Undergoing Percutaneous Coronary Intervention, The Role of Procedural Complexity

Alkhalil, Mohammad; Shahmohammadi, Michael; Spence, Mark S.; Owens, Colum

doi:10.1007/s10557-020-07012-x

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…53 A small study of consecutive patients suggested that the ischemic risk was greater in patients who underwent complex PCI procedures without the use of ASA immediately after a PCI procedure. 54 Therefore, triple therapy should be considered in patients at high risk of ischemia and of stent thrombosis and low risk of bleeding for up to 1 month after PCI (Figure 2). After 1 month, ASA should be stopped, and oral anticoagulation and a P2Y 12 inhibitor (preferably clopidogrel, given its lower bleeding risk) should be continued up to 12 months in patients after acute coronary syndrome.…”

Section: What Are the Indications For Dual Antiplatelet Therapy In Pa...mentioning

confidence: 99%

A practical approach to prescribing antiplatelet therapy in patients with acute coronary syndromes

Alkhalil

Kuzemczak

Bell

et al. 2022

CMAJ

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After an acute coronary syndrome, as many as 1 in 5 patients will have a second ischemic event within 5 years. 1,2 Residual risk is related to several factors that may be mitigated by pharmacologic and nonpharmacologic interventions. 2 Antiplatelet therapy is a cornerstone in the management of acute coronary syndrome. 1,3 Acetylsalicylic acid (ASA) -a cyclooxygenase-1 inhibitor -was introduced as an effective treatment for myocardial infarction almost 5 decades ago and remains the most widely used antiplatelet therapy. 4,5 Although ASA is effective in reducing mortality rates, 6 combining ASA with a second antiplatelet agent, a P2Y 12 receptor inhibitor (known as dual antiplatelet therapy [DAPT]) provides additional benefit and is now the preferred initial strategy for acute coronary syndromes over ASA alone. 7 We review emerging evidence regarding the use of antiplatelet therapy in acute coronary syndromes, as well as updates to the Canad ian and European Society of Cardiology guidelines that highlight adjustments in the choice and duration of antiplatelet therapy, in addition to ASA (Box 1). We particularly focus on strategies to reduce bleeding risk after percutaneous coronary intervention (PCI). 3,8 What are the options for oral antiplatelet therapy?Clopidogrel is a second-generation thienopyridine that has a better safety profile than ticlopidine, a first-generation thienopyridine. 9 Clopidogrel reduces ischemic events by almost 20% when added to ASA for patients presenting with acute coronary syndromes, with or without ST-segment elevation. 7,10,11 It irreversibly antagonizes the receptor for platelet adenosine diphosphate (ADP)-P2Y 12 . The use of clopidogrel may be associated with gastrointestinal symptoms and skin rashes.Prasugrel and ticagrelor are more potent P2Y 12 inhibitors than clopidogrel. Prasugrel is a third-generation thienopyridine that exerts its antiplatelet properties by irreversibly antagonizing the ADP-P 2 Y 12 receptor; similar to clopidogrel, it requires hepatic conversion to its active metabolites. Ticagrelor is part of the cyclopentyltriazolopyrimidine family and does not require hepatic conversion to its active metabolites before reversibly inhibiting the ADP-P 2 Y 12 receptor. Ticagrelor may cause shortness of breath or increased levels of uric acid, which leads to gout.Both prasugrel and ticagrelor provide faster and more consistent inhibition of platelet aggregation and are associated with a further 15%-20% relative risk reduction of ischemic events compared with clopidogrel. 12,13 Ticagrelor also reduces cardiovascular and all-cause mortality rates. 12 Although ticagrelor and prasugrel are associated with greater bleeding risk than clopidogrel, both are recommended over clopidogrel in patients with low bleeding risk. Recently, the

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Section: What Are the Indications For Dual Antiplatelet Therapy In Pa...mentioning

confidence: 99%

A practical approach to prescribing antiplatelet therapy in patients with acute coronary syndromes

Alkhalil

Kuzemczak

Bell

et al. 2022

CMAJ

Self Cite

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“…Fait à noter, ces études n'étaient pas dotées d'une puissance suffisante pour détecter des différences potentielles quant aux événements isché miques, et la métaanalyse a observé un risque accru de throm bose des endoprothèses liée au traitement d'associa tion 53 . Une étude de faible envergure sur des patients consécutifs a laissé entendre que le risque ischémique était plus grand chez les patients ayant subi des ICP complexes sans recevoir d'AAS immédiatement après 54 . Par conséquent, le triple traitement doit être envisagé chez les patients exposés à un risque élevé d'ischémie ou de thrombose des endoprothèses et à un faible risque hémorragique pendant jusqu'à 1 mois après une ICP (figure 2).…”

Section: Quelles Sont Les Indications Du Dtap Chez Les Patients Souff...unclassified

Approche pratique à la prescription des antiplaquettaires chez les patients atteints de syndromes coronariens

Alkhalil

Kuzemczak

Bell

et al. 2022

CMAJ

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“…Moreover, aspirin (ASP) is an inexpensive, chemically stable non-steroidal anti-inflammatory drug (NSAID) [ 22 , 23 ]. Besides its long-term application as a painkiller after operation [ 24 ], ASP also plays an important role in anti-inflammatory effect [ 25 ] and osteogenic differentiation [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

“…Besides its long-term application as a painkiller after operation [ 24 ], ASP also plays an important role in anti-inflammatory effect [ 25 ] and osteogenic differentiation [ 26 ]. Since oral administration of ASP will reduce the drug concentration reaching the local inflammatory area [ 22 ], local application is recommended. In the case of local administration, on one hand, the short half-life of ASP requires repeated administration for maintaining long-term efficacy [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Aspirin/PLGA coated 3D-printed Ti-6Al-4V alloy modulate macrophage polarization to enhance osteoblast differentiation and osseointegration

You

Wang

et al. 2022

J Mater Sci: Mater Med

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Although titanium (Ti) and Ti-based alloy have been widely used as dental and orthopedic implant materials, its bioinertness hindered the rapid osseointegration. Therefore, it is recommended to acquire ideal topographic and chemical characteristics through surface modification methods. 3D printing is a delicate manufacture technique which possesses superior controllability and reproducibility. While aspirin serve as a well-established non-steroidal anti-inflammatory agent. Recently, the importance of immune system in regulating bone dynamics has attracted increasing attention. We herein superimposed the aspirin/poly (lactic–co–glycolic acid) (ASP/PLGA) coating on the 3D-printed Ti-6Al-4V surface with uniform micro-structure to establish the Ti64-M-ASP/PLGA substrate. Scanning electron microscopy (SEM), x-ray photoelectron spectroscopy (XPS) and contact angle test confirmed the successful fabrication of the Ti64-M-ASP/PLGA substrate, with increased wettability and sustained release pattern of ASP. Compared with the Ti64 base material, the Ti64-M-ASP/PLGA substrate showed enhanced M2 and depressed M1 genes and proteins expressions in macrophages. The novel Ti64-M-ASP/PLGA substrate also displayed enhanced osteoblast proliferation, adhesion, extracellular mineralization ability and osteogenic gene expressions when cultured with macrophage conditioned medium in vitro. Furthermore, rat femora implantation model was used for in vivo evaluation. After 4 weeks of implantation, push out test, micro-computed tomography (micro-CT) and histological analyses all confirmed the superior osseointegration capabilities of the Ti64-M-ASP/PLGA implant than the other groups. Our study revealed the synergistic role played by 3D-printed micro topography and immunoregulatory drug aspirin in promoting osteogenesis in vitro and accelerating osseointegration in vivo, thus providing a promising method for better modifying the implant surface.

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Aspirin Discontinuation in Patients Requiring Oral Anticoagulation Undergoing Percutaneous Coronary Intervention, The Role of Procedural Complexity

Cited by 5 publications

References 10 publications

A practical approach to prescribing antiplatelet therapy in patients with acute coronary syndromes

A practical approach to prescribing antiplatelet therapy in patients with acute coronary syndromes

Approche pratique à la prescription des antiplaquettaires chez les patients atteints de syndromes coronariens

Aspirin/PLGA coated 3D-printed Ti-6Al-4V alloy modulate macrophage polarization to enhance osteoblast differentiation and osseointegration

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