New Antithrombotic Drugs in Acute Coronary Syndrome

Zwart, Bastiaan; Parker, William A.; Storey, Robert F.

doi:10.3390/jcm9072059

Cited by 14 publications

(10 citation statements)

References 96 publications

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“…Quercetin derivatives are the protein disulfide isomerase inhibitors, which suppresses TF, inhibit glycoprotein IIb/IIIa activation and platelet aggregation, and decrease thrombin generation and D‐dimer level. 12 These agents decrease reactive oxygen species (ROS) levels and pro‐inflammatory cytokines. By decreasing ROS levels, quercetin can inhibit nod‐like receptor family pyrin domain containing 3 (NLRP3) inflammasome activation.…”

Section: Resultsmentioning

confidence: 99%

“…Quercetin and isoquercetin have anti‐inflammatory and antithrombotic properties. Quercetin derivatives are the protein disulfide isomerase inhibitors, which suppresses TF, inhibit glycoprotein IIb/IIIa activation and platelet aggregation, and decrease thrombin generation and D‐dimer level 12 . These agents decrease reactive oxygen species (ROS) levels and pro‐inflammatory cytokines.…”

Section: Resultsmentioning

confidence: 99%

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Use of novel antithrombotic agents for COVID‐19: Systematic summary of ongoing randomized controlled trials

Talasaz

Sadeghipour

Aghakouchakzadeh

et al. 2021

Journal of Thrombosis and Haemostasis

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Background Coronavirus disease 2019 (COVID‐19) is associated with macro‐ and micro‐thromboses, which are triggered by endothelial cell activation, coagulopathy, and uncontrolled inflammatory response. Conventional antithrombotic agents are under assessment in dozens of randomized controlled trials (RCTs) in patients with COVID‐19, with preliminary results not demonstrating benefit in several studies. Objectives Given the possibility that more novel agents with antithrombotic effects may have a potential utility for management of patients with COVID‐19, we assessed ongoing RCTs including these agents with their potential mechanism of action in this population. Methods We searched clinicaltrials.gov and the World Health Organization International Clinical Trials Registry Platform to identify RCTs of novel antithrombotic agents in patients with COVID‐19. Results Based on a systematic literature search, 27 RCTs with 10 novel antithrombotic agents (including nafamostat, dociparstat, rNAPc2, and defibrotide) were identified. The results from these trials have not been disseminated yet. The studied drugs in the ongoing or completed RCTs include agents affecting the coagulation cascade, drugs affecting endothelial activation, and mixed acting agents. Their postulated antithrombotic mechanisms of action and their potential impact on patient management are summarized. Conclusion Some novel antithrombotic agents have pleiotropic anti‐inflammatory and antiviral effects, which may help reduce the viral load or fibrosis, and improve oxygenation. Results from ongoing RCTs will elucidate their actual role in the management of patients with COVID‐19.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Use of novel antithrombotic agents for COVID‐19: Systematic summary of ongoing randomized controlled trials

Talasaz

Sadeghipour

Aghakouchakzadeh

et al. 2021

Journal of Thrombosis and Haemostasis

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“…Second, we only examined the effects of antithrombotic drugs (alopidogrel, clopidogrel, and LMWH) while antiplatelet (indobufen, and prasugrel) and anticoagulant (rivaroxaban, and dabigatran) medications were not included in our study. As novel antithrombotic drugs in septic patients with peripheral vascular may inhibit thrombosis and bleeding risk [ 30 , 31 ], prospective studies on the effects of these drugs on this pool of patients should be conducted.…”

Section: Discussionmentioning

confidence: 99%

Antithrombotic Therapy Improves ICU Mortality of Septic Patients with Peripheral Vascular Disease

Yuan

Chen

et al. 2022

International Journal of Clinical Practice

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Objective. The effectiveness of antithrombotic drugs for treating sepsis is controversial. Here, we explore the association between antithrombotic therapy and intensive care unit (ICU) mortality for septic patients with peripheral vascular disease. Methods. This retrospective cohort study uses data from the Medical Information Mart for Intensive Care (MIMIC)-III database. Kaplan–Meier survival analyses were used to examine mortality among different groups. Cox regression and marginal structural Cox models (MSCMs) were used to adjust for confounding factors. Main Results. The final cohort from the MIMIC-III database included 776 patients, of which 701 survived and 75 perished. The anticoagulant (AC) group and the antiplatelet-anticoagulation (AC-AP) group survived better than the group without antithrombotic treatment (non-AT). The AC and AC-AP groups showed a 0.363-fold and 0.373-fold risk of ICU mortality, respectively, compared with the non-AT group when controlling for age, gender, CRRT, alcohol, heart failure, hypertension, diabetes, obesity, renal failure, liver disease, INR, PT, PPT, and SpO2. Antiplatelet therapy did not reduce ICU mortality. The same trends were apparent from the MSCM. In addition, the AC-AP group exhibited a lower risk of bleeding complications. Conclusion. Although the antithrombotic group (AC and AC-AP groups) demonstrated a higher sequential organ failure assessment (SOFA) score than the group without antithrombotic treatment (non-AT group), the risk of ICU mortality was lower without increasing the risk of bleeding complications. Our study further suggested that anticoagulation therapy may benefit the prognosis of septic patients with peripheral vascular disease.

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“…Some parenteral antithrombotic drugs that interact with multiple pathways are currently being developed for the treatment of ACS, with the aim of further reducing ischemic events without significantly increasing bleeding complications [35]. Selatogrel is a reversible binding P2Y 12 inhibitor formulated for subcutaneous (SC) administration.…”

Section: Parenteral P2y 12 Inhibitorsmentioning

confidence: 99%

Dual Antiplatelet Therapy with Parenteral P2Y12 Inhibitors: Rationale, Evidence, and Future Directions

Alagna

Mazzone

Contarini

et al. 2023

JCDD

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Dual antiplatelet therapy (DAPT), consisting of the combination of aspirin and an inhibitor of the platelet P2Y12 receptor for ADP, remains among the most investigated treatments in cardiovascular medicine. While a substantial amount of research initially stemmed from the observations of late and very late stent thrombosis events in the first-generation drug-eluting stent (DES) era, DAPT has been recently transitioning from a purely stent-related to a more systemic secondary prevention strategy. Oral and parenteral platelet P2Y12 inhibitors are currently available for clinical use. The latter have been shown to be extremely suitable in drug-naïve patients with acute coronary syndrome (ACS), mainly because oral P2Y12 inhibitors are associated with delayed efficacy in patients with STEMI and because pre-treatment with P2Y12 inhibitors is discouraged in NSTE-ACS, and in patients with recent DES implantation and in need of urgent cardiac and non-cardiac surgery. More definitive evidence is needed, however, about optimal switching strategies between parenteral and oral P2Y12 inhibitors and about newer potent subcutaneous agents that are being developed for the pre-hospital setting.

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New Antithrombotic Drugs in Acute Coronary Syndrome

Cited by 14 publications

References 96 publications

Use of novel antithrombotic agents for COVID‐19: Systematic summary of ongoing randomized controlled trials

Use of novel antithrombotic agents for COVID‐19: Systematic summary of ongoing randomized controlled trials

Antithrombotic Therapy Improves ICU Mortality of Septic Patients with Peripheral Vascular Disease

Dual Antiplatelet Therapy with Parenteral P2Y12 Inhibitors: Rationale, Evidence, and Future Directions

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