Dual antiplatelet therapy for coronary and peripheral arterial disease Books

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Dual Antiplatelet Therapy for Coronary and Peripheral Arterial Disease


Dual Antiplatelet Therapy for Coronary and Peripheral Arterial Disease
  • Author : Sorin Brener
  • Publisher : Academic Press
  • Release : 2021-01-09
  • ISBN : 9780128205372
  • Language : En, Es, Fr & De
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Dual Antiplatelet Therapy for Coronary and Peripheral Arterial Disease is a complete reference containing updated information on the advantages and disadvantages of dual antiplatelet therapy, its duration, composition and anticipated changes. The basis for DAPT in arterial disease is discussed, allowing readers to understand platelet physiology and its relevance to ischemic events. Data on shorter than usual duration of DAPT, and on extended therapy beyond the recommendation of current guidelines is presented in great detail, summarizing a large body of evidence into concrete, relevant recommendation that is readily adaptable by practicing clinicians. A clinically relevant and updated compendium of data pertaining to this field is also presented, as well as the anticipated trends and innovations likely to occur in the next 3-5 years. Summarizes a large body of evidence into concrete, relevant recommendations that is readily adapted by practicing clinicians Explores the current status of DAPT, controversial topics, and future developments and trends in this field Edited and contributed by renowned cardiologists in the field

Antiplatelet Therapy in Cardiovascular Disease


Antiplatelet Therapy in Cardiovascular Disease
  • Author : Ron Waksman
  • Publisher : John Wiley & Sons
  • Release : 2014-03-24
  • ISBN : 9781118494028
  • Language : En, Es, Fr & De
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Edited by one of the world's leading interventional cardiologistsand educators, this new book is created with an eye on giving thereader a solid, practical and clinically-focused understanding ofthis important class of drugs, from basic science to a clear-headeddiscussion of complex topics such as combination therapies,drug-drug interactions, and platelet resistance. This important new book: Begins with a concise but thorough discussion of plateletbiology and pathophysiology so that readers understand how thesetherapies work and why they can also produce such a varied range ofcomplications, from minor gastrointestinal upset, to potentiallylife-threatening conditions such as neutropenia, a criticalshortage of white blood cells. Thoroughly covers platelet function testing, including new,novel techniques. Clarifies current best-practices regarding the use ofantiplatelet agents in both chronic and acute cardiovasculardisease Reviews of all types of antiplatelet agents – fromaspirin to recently approved drugs – including indications,clinical outcomes, and side effects/complications Written by an international who's-who of experts in the field,Antiplatelet Therapy also includes an entire section covering theuse of antiplatelet drugs in PCIs, including percutaneous valverepair, which makes this text particularly essential toInterventional Cardiologists.

Testing of Cyp2c19 Variants and Platelet Reactivity for Guiding Antiplatelet Treatment


Testing of Cyp2c19 Variants and Platelet Reactivity for Guiding Antiplatelet Treatment
  • Author : Agency for Healthcare Research and Quality
  • Publisher : CreateSpace
  • Release : 2015-02-11
  • ISBN : 1508439338
  • Language : En, Es, Fr & De
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Platelets play a role in the development of atherosclerotic vascular diseases such as acute and chronic coronary artery disease, ischemic cerebrovascular disease (i.e., ischemic stroke or transient ischemic attack), and peripheral arterial disease. Specifically, platelet activation and aggregation, and the interaction of platelets with blood cells and the endothelium, contribute to the pathophysiology of these diseases. Furthermore, platelets participate in thrombus formation in the setting of atrial fibrillation. Because of the importance of platelets in disease processes that often culminate in major adverse clinical events (e.g., myocardial infarction, ischemic stroke, or cardiovascular death), there is a strong rationale for the development of therapies specifically targeting platelet function for the primary and secondary prevention of cardiovascular disease. Because patient response to antiplatelet treatments is variable, there is also great interest in developing biomarkers to predict treatment response and guide treatment selection. Approximately 82 million Americans currently suffer from some form of cardiovascular disease. Randomized controlled trials have established dual antiplatelet treatment with clopidogrel and aspirin as the current standard of care for medical and interventional management of acute coronary syndromes. Dual antiplatelet treatment is also recommended for patients undergoing PCI with placement of stents (either bare metal or drug eluting). Randomized controlled trials support the use of clopidogrel in patients who have experienced acute cardiovascular events (e.g., stroke) and those with peripheral arterial disease. For patients with atrial fibrillation and contraindications to vitamin K antagonists, the ACTIVE A (Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events) trial suggested that the combination of clopidogrel and aspirin is more effective than aspirin alone for preventing thromboembolic disease. Since the approval of clopidogrel by the U.S. Food and Drug Administration (FDA) for routine clinical use, the drug has become one of the most commonly prescribed agents in the United States. However, patient response to clopidogrel-based antiplatelet therapy is variable both between patients and across multiple measurements within a patient, with some patients showing no or minimal platelet response to clopidogrel administration (often termed clopidogrel “nonresponsiveness” or “resistance”). Alternatives to standard clopidogrel treatment include higher dose clopidogrel regimens and the use of other antiplatelet agents, such as prasugrel or ticagrelor. Given the availability of alternative antiplatelet strategies and concern about adverse clinical outcomes in clopidogrel nonresponders, research has focused on methods to identify patients who are unlikely to benefit from clopidogrel-based treatment. The question of identifying the optimal antiplatelet therapy may also carry cost implications because generic clopidogrel products are now available in the United States.

The Esc Textbook of Cardiovascular Medicine


The Esc Textbook of Cardiovascular Medicine
  • Author : A. John Camm
  • Publisher : European Society of Cardiology
  • Release : 2018-11-25
  • ISBN : 0198784902
  • Language : En, Es, Fr & De
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This new third edition of The ESC Textbook of Cardiovascular Medicine is a ground breaking initiative from the European Society of Cardiology that is transforming reference publishing in cardiovascular medicine in order to better serve the changing needs of the global cardiology community. Providing the evidence-base behind clinical practice guidelines, with in-depth peer-reviewed articles and broad coverage of this fast-moving field, both the print and digital publication are invaluable resources for cardiologists across the world. Overseen by Professors A. John Camm, Thomas F. Lüscher, Patrick W. Serruys, and Gerald Maurer, supported by an editorial board of subject experts, and more than 900 of the world's leading specialists from research and the clinic contributing, this dynamic encyclopaedic resource covers more than 63 disciplines within cardiology. Split into six key parts; Introduction to the cardiovascular system; Investigations; Heart diseases; Vascular disease; Special populations, and Other aspects of cardiology, providing readers with a trustworthy insight into all aspects of cardiovascular medicine. To respond nimbly to the rapid evolution of the field the digital publication, ESC CardioMed, is continuously updated by the author teams. With expert editors and authors, and stringent peer-review, the publication combines the discoverability of digital with the highest standards of academic publishing. Highly illustrated with embedded multi-media features, along with cross-referenced links to ESC Clinical Practice Guidelines, related content and primary research data in European Heart Journal, as well as all other major journals in the field, ESC CardioMed provides users with the most dynamic and forward thinking digital resource at the heart of cardiology. As a consistently evolving knowledge base, the ESC Textbook of Cardiovascular Medicine 3e together with the online counterpart ESC CardioMed, equips all those, from trainees and consultants, to device specialists and allied healthcare professionals with a powerful, multifaceted resource covering all aspects of cardiovascular medicine.

EPIDURAL ANESTHESIA FOR MANAGEMENT OF PSEUDO ANEURYSM OF FEMORAL ARTERY IN ASA IV PATIENT ON DUAL ANTIPLATELET THERAPY CASE REPORT PARADIGM SHIFT IN ANAESTHESIA PRACTICE


EPIDURAL ANESTHESIA FOR MANAGEMENT OF PSEUDO ANEURYSM OF FEMORAL ARTERY IN ASA  IV PATIENT ON DUAL ANTIPLATELET THERAPY  CASE REPORT PARADIGM SHIFT IN ANAESTHESIA PRACTICE
  • Author : Sherif Abeer
  • Publisher :
  • Release : 2017
  • ISBN : OCLC:1163822074
  • Language : En, Es, Fr & De
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Epidural anesthesia for management of pseudo aneurysm of femoral artery in ASA- IV patient on dual antiplatelet therapy: Case report and a paradigm shift in anaesthesia practiceAbeer A. Sherif, MD(1), Abdulatif Araji, MD(2) (1) Professor of anaesthesia & Pain medicine, Faculty of Medicine, El-menufia university, Consultant & Chief anaesthesiologist NMC royal hospital UAE (2) Vascular surgeon, NMC Royal hospital, UAEIntroduction: Anticoagulation achieved with dual antiplatelet therapy is becoming increasingly common after coronary angioplasty and represents an everyday challenge to the anaesthesiologists when neuraxial anaesthesia is to be considered specially in high risk patients with multiple comorbidities. Epidural hematoma is a rare but potentially devastating complication of neuraxial anesthesia. To date, no clear data addressing the safety of epidural anesthesia in patients on dual antiplatelet therapy. Despite being extremely rare, the development of epidural hematoma is a known risk after epidural analgesia. The third National Audit Project of the Royal College of Anesthetists found an incidence of two in 100 000 cases. The incidence of spontaneous epidural hematoma is rarer, estimated at 1 per 1 000 000 patients per year, most going undetected. Antiplatelet agents are known to be protective in most patients at increased risk of occlusive vascular events, including those with an acute myocardial infarction, ischemic stroke, angina, peripheral arterial disease, or atrial fibrillation. Brilianta (ticagrelor) is a platelet adenosine diphosphate (ADP) P2Y12 receptor inhibitor, a new oral anticoagulants are approved for a variety of clinical syndromes like coronary artery disease, peripheral vascular disease, or ischaemic strokes. Current ASRA recommendations to stop Brilianta (Ticagrelor) therapy 5 - 7 days before the surgery are based on level III evidence such as clinical judgement and sporadic case reports of epidural hematoma after regional analgesia, in patients with a history of taking Tecagrelor in combination with other anticoagulants ( level C evidence). To date, no prospective studies have investigated the safety of epidural analgesia in patients actively taking Ticagrelor.Methods: A 80-year-old man presented with a history of swelling and redness in his left groin. Patients was on aspirin and brilianta after angioplasty 3 month ago, ischemic nephropathy, COPD, sever chest infection, heart failure and pacemaker in place. Epidural anesthesia was planned because of the poor general condition of the patient. Epidural was conducted in the sitting position using L 3- 4 interspaces, 10 ml of bupivacaine 0.5% was injected in the epidural catheter. Primary repair of the femoral vein performed, along with the patching of the left common femoral artery. The surgical procedure lasted for 6 hours and the patient was shifted to ICU for monitoring. The intraoperative as well as the postoperative period remained uneventful.Discussion:The risk of central neuraxial blockade in patients treated with newer antiplatelet drugs is unclear. However, a disturbing lack of data exists concerning the safety of neuroaxial blockade in such patients, with a wide difference in opinion not only among anesthetists but also between published guidelines. The American Society of Regional Anesthesia agreed on an interval of 5 - 7 days between discontinuation of Brilianta (Ticagrelor) therapy and neuraxial blockade. In the current case the patient had recently undergone a coronary artery stent implantation and was treated with both Brilianta, and aspirin. Despite this dual antiplatelet therapy, uneventful epidural anesthesia at two levels was carried out. Our case report demonstrate that, for certain high-risk patients, the benefit of placing an epidural catheter while actively taking antiplatelet therapy may be considered. Conclusion:Epidural anesthesia was conducted safely for emergency vascular surgery, in high risk patient with multiple comorbidities. Decision to perform regional anesthesia in the patients receiving antithrombotic drugs should be made on an individual basis weighing risk of epidural hematoma with the benefits of regional anesthesia. This report is not meant to recommend the liberal placement of epidural catheters in patients actively taking dual antiplatelet therapy. prospective studies with a large number of patients are needed in order to give more accurate recommendation regarding performing epidural block in such population.References: 1-tHorlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med 2003; 28: 172u201397.2-tCook T, Counsell D, Wildsmith J. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth 2009; 102: 179u201390.3-tHorlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Regional Anesthesia and Pain Medicine 2003; 28: 172u201397.