Clinical pathways and management of antithrombotic therapy in patients with acute coronary syndrome (ACS): a Consensus Document from the Italian Association of Hospital Cardiologists (ANMCO), Italian Society of Cardiology (SIC), Italian Society of Emergency Medicine (SIMEU) and Italian Society of Interventional Cardiology (SICI-GISE)

Luca, Leonardo De; Colivicchi, Furio; Gulizia, Michele Massimo; Pugliese, Francesco; Ruggieri, Maria Pia; Musumeci, Giuseppe; Cibinel, Gian Alfonso; Romeo, Francesco

doi:10.1093/eurheartj/sux013

Cited by 7 publications

(4 citation statements)

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“…Coronary vascular endothelial dysfunction leads to platelet activation, adhesion, aggregation, and thrombosis, causing severe occlusion of culprit vessels and the induction of severe myocardial ischemia or even necrosis in STEMI patients [6]. Today, antithrombotic therapy is the mainstay of STEMI treatment [7]. Considering that platelet activation plays a key role in the occurrence and development of STEMIs, antiplatelet drugs, including aspirin and clopidogrel, have become the cornerstone of STEMI treatment [6, 8].…”

Section: Introductionmentioning

confidence: 99%

Short-term efficacy of ticagrelor in acute ST-segment elevation myocardial infarction patients undergoing an emergency percutaneous coronary intervention

Cao

Xianliang

et al. 2019

Aging

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In total, 97 acute ST-segment elevation myocardial infarction (STEMI) patients who received an emergency percutaneous coronary intervention (PCI) were enrolled and divided into a ticagrelor group and a clopidogrel group. Thrombolysis in myocardial infarction (TIMI) blood flow and the corrected TIMI frame count (CTFC) were used to assess the blood perfusion of culprit vessels. Thromboelastography (TEG) was used to evaluate the antiplatelet effect of drugs. The results showed that the incidence of TIMI grade III blood flow in the ticagrelor group was significantly higher than that in the clopidogrel group. The CTFC in the anterior descending, circumflex, and right coronary arteries was statistically significantly lower in the ticagrelor group as compared with that in the clopidogrel group. At 2 h and 7 d postdrug treatment, the adenosine diphosphate-induced platelet inhibition rate (ADP%) in the ticagrelor group increased significantly as compared with that in the clopidogrel group, and the platelet aggregation rate of the ADP pathway (MAADP) decreased significantly in the ticagrelor group versus that in the clopidogrel group. In conclusion, ticagrelor significantly improved TIMI blood flow and had a better antiplatelet effect than clopidogrel in STEMI patients undergoing an emergency PCI.

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Section: Introductionmentioning

confidence: 99%

Short-term efficacy of ticagrelor in acute ST-segment elevation myocardial infarction patients undergoing an emergency percutaneous coronary intervention

Cao

Xianliang

et al. 2019

Aging

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“…The details are as follows: in ST-elevation myocardial infarction patients who receive thrombolytic therapy, UFH or enoxaparin should be used around the time of reteplase or alteplase therapy. For patients with conservative treatment or percutaneous coronary intervention, bivalirudin is the better choice than UFH if patients are at a high risk of bleeding [55]. After hospital discharge, ACEIs/ARBs, statins, β-blockers and low doses of aspirin should be indefinitely continued, and 12 months of P2Y12 receptor antagonist therapy is needed.…”

Section: Results: Prevention Of Thrombogenesis and The Anticoagulant mentioning

confidence: 99%

Management of anticoagulation and antiplatelet therapy in patients with primary membranous nephropathy

Zou

2019

BMC Nephrol

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BackgroundIt has been recognized that primary membranous nephropathy (MN) is related to an increased risk for thromboembolic complications. However, the current evidence supporting prophylactic and therapeutic anticoagulation is too weak to better meet the clinical needs of this patient population. The present review provides some suggestions to guide the decision on anticoagulant management in primary MN patients with a high risk of thrombosis or with thromboembolic complication.Materials and methodsWe extracted relevant studies by searching the published literature using the Cochrane Library, Medline, PubMed and Web of Science from March 1968 to March 2018. Eligible publications included guidelines, reviews, case reports, and clinical trial studies that concerned the rational management of anticoagulation therapy in the primary MN population. The evidence was thematically synthesized to contextualize implementation issues.ResultsIt was helpful for clinicians to make a decision for personalized prophylactic aspirin or warfarin in primary MN patients when serum albumin was < 3.2 g/dl to prevent arterial and venous thromboembolic events (VTEs). The treatment regimen for thromboembolic complications (VTEs, acute coronary syndrome and ischemic stroke) in primary MN was almost similar to that for the general population with thromboembolic events. It is noteworthy that patients should continue the previous primary MN treatment protocol during the entire treatment period until they achieve remission, the protocol is complete and the underlying diseases resolve.ConclusionThe utility of prophylactic aspirin or warfarin may have clinical benefits for the primary prevention of thromboembolic events in primary MN with hypoalbuminemia. It is necessary to perform large randomized controlled trials and to formulate relevant guidelines to support the present review.

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“…Also, GPIs may have a place in very high risk procedures or when an intense platelet inhibition is needed, for example in STEMI patients that did not or could not receive normal antiplatelet loading doses. Also, in isolated cases, when there is a large ischaemic area at risk, GPIs may be given upstream 34 . When using GPIs it is mandatory to always evaluate the individual bleeding risk of the patient.…”

Section: Ticagrelormentioning

confidence: 99%

Antithrombotic Therapy in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary PCI

Батайла¹,

Popa-Fotea²,

Onciul³

et al. 2019

Rev. Med. Mod.

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Ischemic heart disease is one of the most prevalent diseases with a high impact on mortality and morbidity. The main process implicated in acute coronary syndromes (ACS) including its most severe form, the ST elevation myocardial infarction (STEMI), is the development of thrombosis subsequently of plaque erodation or rupture. The thrombus is formed by aggregates of platelets that furthermore drive the process of coagulation, that in this turn stimulates platelet aderation and aggregation, causing a vicious circle. From these physiopathological mechanims derive the indication and role of antiplatelets and anticoagulation in STEMI. Antiplatelets and anticoagulants play a central role in the therapeutic management of STEMI along with the interventional therapy. Correctly conducted by all physicians involved in the management of patients with STEMI, it reduces the area of ischemia, as well as mortality and other major adverse cardiovascular events. The following article will review the antithrombotic treatment adjuvant to the interventional treatment and the evidence based indications for treatment in STEMI. RezumatBoala cardiacă ischemică este una dintre cele mai prevalente boli cu un impact major asupra mortalităţii și morbidităţii. Principalul proces implicat în sindroamele coronariene acute (SCA), incluzând forma sa cea mai severăinfarctul miocardic acut cu supradenivelare de segment ST (STEMI), este tromboza ce urmează în general erodării sau rupturii plăcii de aterom. Trombul este format din agregate plachetare care mai departe activează calea coagulării, care la rândul său stimulează aderarea și agregarea plachetară creând un cerc vicios cu potenţare reciprocă. Din aceste mecanisme fi ziopatologice derivă indicaţia și rolul tratamentelor antiagregante și anticoagulante în STEMI, terapia antiagregantă împreună cu cea antiacogulantă jucând un rol central în managementul STEMI alături de terapia intervenţională. Un tratament corect administrat de către toţi medicii implicaţi ajută la reducerea ariei de ischemie, precum și la scăderea mortalităţii și a celorlalte evenimente adverse cardiovasculare majore. Articolul reprezintă o revizuire a tratamentului antitrombotic premergător terapiei de reperfuzie intervenţionale, precum și a indicaţiilor de ghid bazate pe dovezi pentru tratamentul STEMI. Cuvinte cheie: sindroame coronariene acute, STEMI, antiagregante, anticoagulante, ghiduri, balanţa risc-benefi ciu, risc ischemic, angioplastie primară. REVIEWVlad BATAILA et al. Modern Medicine | 2019, Vol. 26, No. 3 112 ADP-receptor inhibitors ClopidogrelClopidogrel is a second-generation irreversible inhibitor of P2Y12 receptor protein from the family of thienopyridines. It was patented in 1982 and approved for medical use in 1998 being currently on the WHO list of the safest and most eff ective drugs 9 . Clopidogrel followed ticlopidine, the fi rst member of the thienopyridine family, but with a much faster onset of acti-

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Cited by 7 publications

References 126 publications

Short-term efficacy of ticagrelor in acute ST-segment elevation myocardial infarction patients undergoing an emergency percutaneous coronary intervention

Short-term efficacy of ticagrelor in acute ST-segment elevation myocardial infarction patients undergoing an emergency percutaneous coronary intervention

Management of anticoagulation and antiplatelet therapy in patients with primary membranous nephropathy

Antithrombotic Therapy in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary PCI

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