Academic literature on the topic 'Oral P2Y12 inhibitor'

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Journal articles on the topic "Oral P2Y12 inhibitor"

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Prüller, Florian, Lukasz Bis, Oliver Milke, Friedrich Fruhwald, Sascha Pätzold, Siegfried Altmanninger-Sock, Jolanta Siller-Matula, et al. "Cangrelor Induces More Potent Platelet Inhibition without Increasing Bleeding in Resuscitated Patients." Journal of Clinical Medicine 7, no. 11 (November 15, 2018): 442. http://dx.doi.org/10.3390/jcm7110442.

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Dual antiplatelet therapy is the standard of care for patients with myocardial infarction (MI), who have been resuscitated and treated with therapeutic hypothermia (TH). We compare the antiplatelet effect and bleeding risk of intravenous cangrelor to oral P2Y12-inhibitors in patients with MI receiving TH in a prospective comparison of two matched patient cohorts. Twenty-five patients within the CANGRELOR cohort were compared to 17 patients receiving oral P2Y12-inhibitors. CANGRELOR group (NCT03445546) and the ORAL P2Y12 Group (NCT02914795) were registered at clinicaltrials.gov. Platelet function testing was performed using light-transmittance aggregometry and monitored for 4 days. P2Y12-inhibition was stronger in CANGRELOR compared to ORAL P2Y12 (adenosine diphosphate (ADP) (area under the curve (AUC)) 26.0 (5.9–71.6) vs. 160.9 (47.1–193.7)) at day 1. This difference decreased over the following days as more patients were switched from CANGRELOR to oral P2Y12-inhibitor treatment. There was no difference in the effect of aspirin between the two groups. We did not observe significant differences with respect to thrombolysis in myocardial infarction (TIMI) or Bleeding Academic Research Consortium (BARC) classified bleedings, number of blood transfusions or drop in haemoglobin B (Hb) or hematocrit (Hct) over time. Cangrelor treatment is not only feasible and effective in resuscitated patients, but also inhibited platelet function more effectively than orally administered P2Y12-inhibitors without an increased event rate for bleeding.
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Alexopoulos, Dimitrios, Stylianos Dragasis, and Nikolaos Kafkas. "Loading with Oral P2Y12 Receptor Inhibitors: To Crush or Not to Crush?" Thrombosis and Haemostasis 119, no. 07 (May 12, 2019): 1037–47. http://dx.doi.org/10.1055/s-0039-1688790.

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AbstractOral P2Y12 receptor inhibitors represent a mainstay treatment in patients with acute coronary syndrome and those undergoing percutaneous coronary intervention. In the setting of ST-elevation myocardial infarction, when early platelet inhibition is highly desirable, the onset of action of oral P2Y12 receptor inhibitors is, however, delayed, likely due to delayed drug absorption. Crushing the tablets, which are to be used for patient loading with an oral P2Y12 receptor inhibitor, has been shown to provide earlier platelet inhibition than standard, integral tablets administration. Chewed ticagrelor tablets may also result in a similar effect. Such findings should be interpreted with caution, mainly due to the small number of patients enrolled and the nature (pharmacodynamic/pharmacokinetic) of the respective studies. Furthermore, in patients with out-of-hospital cardiac arrest, who remain comatose, crushing tablets is commonly applied in clinical practice for platelet P2Y12 receptor inhibition. In this review, we focus on current evidence regarding the role of crushed P2Y12 receptor inhibitor pills, analyzing clinical scenarios where most of the promise exists along with future expectations from this type of formulation. Large randomized studies are needed to draw firm conclusions regarding the clinical benefit of ‘crushing’ over the usual ‘not-crushing’ practice.
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Stratz, Christian, Thomas Nührenberg, Christian Valina, Nikolaus Löffelhardt, Kambis Mashayekhi, Miroslaw Ferenc, Dietmar Trenk, Franz-Josef Neumann, and Willibald Hochholzer. "Impact of Reticulated Platelets on the Antiplatelet Effect of the Intravenous P2Y12-Receptor Inhibitor Cangrelor." Thrombosis and Haemostasis 118, no. 02 (2018): 362–68. http://dx.doi.org/10.1160/th17-07-0466.

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Background Reticulated platelets are associated with impaired antiplatelet response to irreversibly acting P2Y12-receptor inhibitors. However, the impact of reticluated platelets (RP) on the reversibly acting injectable P2Y12-receptor inhibitor cangrelor is unknown. Thus, this study sought to investigate the influence of RP on cangrelor and transitioning strategies to oral P2Y12-receptor inhibitors. Methods This study randomized 110 patients undergoing elective percutaneous coronary intervention with use of cangrelor to different oral transitioning strategies loading with prasugrel 60 mg or ticagrelor 180 mg at the start of cangrelor (n = 45 each) or loading with clopidogrel 600 mg after discontinuation of cangrelor (n = 20). ADP-induced platelet reactivity was assessed by impedance aggregometry. Reticulated platelets were analysed by an automated whole blood flow cytometry and described as immature platelet count. Results There was no correlation of reticulated platelets and ADP-induced platelet reactivity in patients under treatment with cangrelor (r = 0.06, p = 0.47). This finding was consistent in all three transitioning strategies. On day 1 following treatment with cangrelor, the correlation of reticulated platelets and platelet reactivity was detectable again in patients receiving thienopyridines but not ticagrelor (all patients r = 0.37, p < 0.001; clopidogrel: r = 0.59, p = 0.01; prasugrel: r = 0.47, p < 0.001; ticagrelor r = 0.22, p = 0.13). Conclusion Platelet inhibition is not influenced by levels of reticulated platelets during infusion of cangrelor independent of oral P2Y12-receptor inhibitor transitioning strategy. These findings underline the potency of cangrelor as immediate and reversibly acting P2Y12-receptor inhibitor.
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Zhou, Xuan, Dominick J. Angiolillo, and Luis Ortega-Paz. "P2Y12 Inhibitor Monotherapy after Percutaneous Coronary Intervention." Journal of Cardiovascular Development and Disease 9, no. 10 (October 6, 2022): 340. http://dx.doi.org/10.3390/jcdd9100340.

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In patients with acute and chronic coronary artery disease undergoing percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) has been the cornerstone of pharmacotherapy for the past two decades. Although its antithrombotic benefit is well established, DAPT is associated with an increased risk of bleeding, which is independently associated with poor prognosis. The improvement of the safety profiles of drug-eluting stents has been critical in investigating and implementing shorter DAPT regimens. The introduction into clinical practice of newer generation oral P2Y12 inhibitors such as prasugrel and ticagrelor, which provide more potent and predictable platelet inhibition, has questioned the paradigm of standard DAPT durations after coronary stenting. Over the last five years, several trials have assessed the safety and efficacy of P2Y12 inhibitor monotherapy after a short course of DAPT in patients treated with PCI. Moreover, ongoing studies are testing the role of P2Y12 inhibitor monotherapy immediately after PCI in selected patients. In this review, we provide up-to-date evidence on the efficacy and safety of P2Y12 inhibitor monotherapy after a short period of DAPT compared to DAPT in patients undergoing PCI as well as outcomes associated with P2Y12 inhibitor monotherapy compared to aspirin for long-term prevention.
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Droppa, Michal, Oliver Borst, Dominik Rath, Karin Müller, Meinrad Gawaz, Deepak L. Bhatt, and Tobia Geisler. "Impact of Intravenous P2Y12-Receptor Inhibition with Cangrelor in Patients Presenting with Acute Coronary Syndrome and Cardiogenic Shock – a Case Series." Cellular Physiology and Biochemistry 42, no. 4 (2017): 1336–41. http://dx.doi.org/10.1159/000478962.

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Background/Aims: Patients with acute coronary syndromes (ACS) presenting with cardiogenic shock (CS) are at particular risk for death and adverse cardiac events. Impaired effects and absorption of oral P2Y12-receptor inhibitors due to decreased organ hypoperfusion or hypothermia and challenges regarding oral administration contribute to this risk. We report a single center experience regarding the use of intravenous P2Y12-receptor inhibitor cangrelor in patients with CS treated with percutaneous coronary intervention (PCI). Methods: Twelve patients with ACS and CS undergoing PCI, not pretreated with oral P2Y12-receptor inhibitors, were treated with cangrelor. Platelet inhibition was assessed by multiple electrode aggregometry (MEA) before and after PCI, immediately and 2 hours after stopping the cangrelor infusion. Results: Nine patients recovered from their cardiogenic shock, 3 patients died. Platelet reactivity decreased from 65.9 (SD 41.0) U before PCI to 15.8 (SD 10.8) U after PCI, 13.4 (SD 7.7) U at the end of infusion and 33.8 (SD 19.9) 2 hours after stopping the cangrelor infusion. There was no non-responder under cangrelor infusion (MEA < 46 U). Conclusions: Due to its favorable PK/PD profile, cangrelor overcomes problems with reduced absorption and effects of oral P2Y12-receptor inhibitors and should be considered for periprocedural treatment of patients with CS.
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Menozzi, Alberto, and Giorgio Caretta. "Acute coronary syndromes with high thrombotic burden: therapeutic innovations." European Heart Journal Supplements 22, Supplement_L (November 1, 2020): L97—L100. http://dx.doi.org/10.1093/eurheartj/suaa144.

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Abstract Antiplatelet agents represent one of the cornerstones of drug therapy for acute coronary syndromes (ACS). In the last decade, the arrival of prasugrel and ticagrelor, faster and more powerful oral platelet receptor P2Y12 inhibitors compared to clopidogrel, significantly improved platelet inhibition in patients with ACS. However, the reduction of thrombotic risk came at the cost of increased bleeding risk. Despite having similar indications, prasugrel and ticagrelor have different characteristics and methods of use, essentially due to a different design of the trials in which they have been studied. The optimal use of these antiplatelets in clinical practice should therefore be tailored in individual patients. In the acute phase of ACS with high thrombotic burden, all oral P2Y12 inhibitors have limitations, mainly due to the delay of onset of action related to oral administration. In this scenario, parenteral antiplatelet agents (glycoprotein inhibitors IIb/IIIa and cangrelor) may play a key role in case of percutaneous coronary interventions of high thrombotic coronary lesions and in the prevention of early thrombotic complications. Cangrelor, an intravenous inhibitor of the P2Y2 receptor, has peculiar pharmacokinetic and pharmacodynamic characteristics that make it particularly suitable to be used as an antiplatelet during coronary angioplasty as it achieves a rapid and powerful antiplatelet effect in patients not pretreated with oral medications, and has a favourable safety profile in relation to the bleeding risk.
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Jhagroe, Darshni Arishta, and Jurriën Maria ten Berg. "Managing the Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients on Oral Anticoagulation." Interventional Cardiology Review 10, no. 3 (2015): 139. http://dx.doi.org/10.15420/icr.2015.10.03.139.

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In patients on chronic oral anticoagulation (OAC) who are undergoing a percutaneous coronary intervention (PCI), dual antiplatelet therapy (aspirin and a P2Y12 inhibitor) is required. However, combining dual antiplatelet therapy with OAC increases the risk of bleeding. Newer and stronger P2Y12 inhibitors also add more complexity to the regimen, as these antiplatelet agents are currently recommended as standard treatment in patients with acute coronary syndromes (ACS). It remains unclear whether these ACS patients on chronic OAC undergoing PCI should be treated with these new P2Y12 inhibitors as part of the antiplatelet therapy. Another issue to address is that new non-vitamin K oral anticoagulants have emerged as possible alternatives for stroke prevention in patients with AF. Thus, the anticoagulated patient undergoing PCI faces a treatment dilemma. Based on a real-life case, we will discuss the optimal anticoagulant and antiplatelet treatment with a review of the literature.
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Vlachou, Maria, Matthaios Didagelos, Antonios Kouparanis, Haralambos Karvounis, and Antonios Ziakas. "Bridging with Tirofiban During Temporary Withdrawal of Oral Antiplatelets for Two Major Surgical Procedures in High Ischaemic Risk Patients." Open Cardiovascular Medicine Journal 13, no. 1 (February 15, 2019): 1–4. http://dx.doi.org/10.2174/1874192401913010001.

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Background: Recent coronary stent implantation requires Dual Antiplatelet Therapy (DAPT) for at least 6 months. Serious issues are raised when non-cardiac surgery is required during this period, because of the balance between ischemic and haemorrhagic complications. Case Reports: We report 2 high ischemic risk cases requiring intermediate bleeding risk non-cardiac surgery, during the first month of DAPT initiation. Perioperative management with discontinuation of the P2Y12 inhibitor and bridging with tirofiban, while aspirin was uninterrupted, was uneventful. Conclusion: Bridging with intravenous glycoprotein IIb/IIIa receptor inhibitors may be a safe and effective alternative to P2Y12 inhibitor discontinuation in non-deferrable non-cardiac surgery.
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Chua, Su-Kiat, Lung-Ching Chen, Kou-Gi Shyu, Jun-Jack Cheng, Huei-Fong Hung, Chiung-Zuan Chiu, and Chiu-Mei Lin. "Antithrombotic Strategies in Patients with Atrial Fibrillation Following Percutaneous Coronary Intervention: A Systemic Review and Network Meta-Analysis of Randomized Controlled Trials." Journal of Clinical Medicine 9, no. 4 (April 8, 2020): 1062. http://dx.doi.org/10.3390/jcm9041062.

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Up to 10% of patients with atrial fibrillation (AF) undergo percutaneous coronary intervention (PCI). A systematic review and network meta-analysis were conducted by searching PubMed, Embase, and the Cochrane database of systematic reviews for randomized control trials that studied the safety and efficacy of different antithrombotic strategies in these patients. Six studies, including 12,158 patients were included. Compared to that in the triple antithrombotic therapy group (vitamin K antagonist (VKA) plus P2Y12 inhibitor and aspirin), thrombolysis in myocardial infarction (TIMI) major bleeding was significantly reduced in the dual antithrombotic therapy (non-vitamin K oral anticoagulants (NOACs) plus P2Y12 inhibitor) group by 47% (Odds ratio (OR), 0.53; 95% credible interval [CrI], 0.35–0.78; I2 = 0%). Besides, NOAC plus a P2Y12 inhibitor was associated with less intracranial hemorrhage compared to VKA plus single antiplatelet therapy (OR: 0.20, 95% CrI: 0.05–0.77). There was no significant difference in the trial-defined major adverse cardiac events or the individual outcomes of all-cause mortality, cardiovascular death, myocardial infarction, stroke or stent thrombosis among all antithrombotic strategies. In conclusion, antithrombotic strategy of NOACs plus P2Y12 inhibitor is safer than, and as effective as, the strategies including aspirin when used in AF patients undergoing PCI.
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Lupercio, Florentino, Shaun Giancaterino, Pedro Arturo Villablanca, Frederick Han, Kurt Hoffmayer, Gordon Ho, Farshad Raissi, et al. "P2Y12 inhibitors with oral anticoagulation for percutaneous coronary intervention with atrial fibrillation: a systematic review and meta-analysis." Heart 106, no. 8 (February 7, 2020): 575–83. http://dx.doi.org/10.1136/heartjnl-2019-315963.

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ObjectiveThis study aimed to compare the safety and efficacy of third-generation P2Y12 inhibitors versus clopidogrel in combination with oral anticoagulation (OAC) with or without aspirin in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).MethodsWe performed a systematic review including both prospective and retrospective studies that compared dual and triple antithrombotic regimens for bleeding and major adverse cardiac events (MACE) in patients with AF undergoing PCI. We analysed rates of bleeding and MACE by P2Y12 inhibitor choice. Risk ratio (RR) 95% CIs were measured using the Mantel-Haenszel method. Where study heterogeneity was low (I2 <25%), we used the fixed effects model, otherwise the random effects model was used.ResultsA total of 22 014 patients were analysed from the seven studies included. Among patients treated with both OAC and P2Y12 inhibitor with or without aspirin, 90% (n=9708) were treated with clopidogrel, 8% (n=830) with ticagrelor, and 2% (n=191) with prasugrel. When compared with clopidogrel, use of ticagrelor (RR 1.36; 95% CI 1.18 to 1.57) and prasugrel (RR 2.11; 95% CI 1.34 to 3.30) were associated with increased rates of bleeding. Compared with clopidogrel, there were no significant differences in rates of MACE with ticagrelor (RR 1.03; 95% CI 0.65 to 1.62) or prasugrel (RR 1.49; 95% CI 0.69 to 3.24).ConclusionBased on this meta-analysis, the use of clopidogrel is associated with a lower rate of bleeding compared with ticagrelor or prasugrel in patients with AF on OAC undergoing PCI.
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Dissertations / Theses on the topic "Oral P2Y12 inhibitor"

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Khan, Nazish. "The clinical efficacy of oral P2Y12 inhibitor antiplatelet therapies during an acute myocardial infarction in patients undergoing percutaneous coronary intervention." Thesis, University of Birmingham, 2017. http://etheses.bham.ac.uk//id/eprint/7315/.

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Introduction: In patients who present with ST-elevation myocardial infarction (STEMI), primary percutaneous coronary intervention and the administration of dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor) are recommended. This thesis aimed to determine the extent to which oral P2Y12 inhibitors (clopidogrel/prasugrel/ticagrelor) exert their antiplatelet effect during the acute phase of a STEMI compared to non-ST elevation myocardial infarction (NSTEMI). Methods: The degree and time-course of platelet inhibition following oral administration of P2Y12 inhibitors was determined in 87 patients from their pharmacokinetic (plasma concentration) and pharmacodynamic (degree of platelet inhibition) profiles at 20 minutes, balloon inflation, 60 and 240 minutes using liquid chromatography/mass spectrometry, VerifyNow and VASP-phosphorylation assays. Results: In STEMI patients, oral P2Y12 inhibitors do not provide adequate levels of platelet inhibition at the time of angioplasty and have a limited effect at 240 minutes. The NSTEMI group displayed a marked and rapid antiplatelet effect at all time points. A significant difference in the acute efficacy of oral P2Y12 inhibitors in STEMI vs NSTEMI patients (p < 0.001) was seen. Conclusion: Oral P2Y12 inhibitors display delayed and attenuated antiplatelet effects in STEMI patients in the immediate period following administration of a loading dose when compared with NSTEMI patients.
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Books on the topic "Oral P2Y12 inhibitor"

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Valgimigli, Marco, and Marco Angelillis. Treatment of non-ST elevation acute coronary syndromes. Edited by Stefan James. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0311.

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Treatment of patients presenting with a non-ST elevation acute coronary syndrome (NSTE-ACS) aims at immediate relief of ischaemia and the prevention of serious adverse events, including death, myocardial (re)infarction, and life-threatening arrhythmias. In NSTE-ACS, patient management is guided by risk stratification (troponin, electrocardiogram, risk scores, etc.). Treatment options include anti-ischaemic and antithrombotic drugs and coronary revascularization including percutaneous coronary interventions, or coronary artery bypass grafting. While long-term secondary prevention with aspirin monotherapy is currently the gold standard approach for all NSTE-ACS patients who tolerate the drug, additional medications on top of aspirin such as oral P2Y12 inhibitors or oral anticoagulation have been investigated across clinical trials and their long-term use should be guided by the ischaemic versus bleeding risk status of each single individual patient.
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Book chapters on the topic "Oral P2Y12 inhibitor"

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"Direct oral P2Y12 inhibition: AZD6140 (Ticagrelor)." In Clinical Guide to the Use of Antithrombotic Drugs in Coronary Artery Disease, 113–18. CRC Press, 2008. http://dx.doi.org/10.3109/9780203091494-18.

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Becker, Richard C., and Frederick A. Spencer. "Clopidogrel." In Fibrinolytic and Antithrombotic Therapy. Oxford University Press, 2006. http://dx.doi.org/10.1093/oso/9780195155648.003.0013.

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Clopidogrel, a thienopyridine derivative, is a novel platelet antagonist that is several times more potent than ticlopidine but associated with fewer adverse effects. After repeated 75-mg oral doses of clopidogrel, plasma concentrations of the parent compound, which has no platelet-inhibiting effect, are very low. Clopidogrel is extensively metabolized in the liver. The main circulating metabolite is a carboxylic acid derivative with a plasma elimination half-life of 7.7 ± 2.3 hours. Approximately 50% of an oral dose is excreted in the urine and the remaining 50% in feces over the following 5 days. Dose-dependent inhibition of platelet aggregation is observed 2 hours after a single oral dose of clopidogrel, with a more significant inhibition achieved with loading doses (≥300 mg) by approximately 6 hours. Repeated doses of 75 mg of clopidogrel per day inhibit adenosine diphosphate (ADP)-mediated aggregation, with steady state being reached between day 3 and day 7. At steady state, the average inhibition to ADP is between 40% and 60%. Based on ex vivo studies, clopidogrel is approximately 100-fold more potent than ticlopidine. There are no cumulative antiplatelet effects with prolonged oral administration. The combined administration of clopidogrel (300 mg loading dose) and aspirin yields a readily discernible platelet-inhibiting effect within 90 to 120 minutes. Clopidogrel selectively inhibits the binding of ADP to its platelet receptor (P2Y12) and the subsequent G-protein–linked mobilization of intracellular calcium and activation of the glycoprotein (GP)IIb/IIIa complex (Gachet et al., 1992). The specific receptor has been cloned and is abundantly present on the platelet surface (Hollopter et al., 2001). Clopidogrel has no direct effect on cyclooxygenase, phosphodiesterase, or adenosine uptake. Clopidogrel is rapidly absorbed following oral administration with peak plasma levels of the predominant circulating metabolite occurring approximately 60 minutes later. Administration with meals does not significantly modify the bioavailability of clopidogrel. The available information suggests that clopidogrel offers safety advantages over ticlopidine, particularly with regard to bone marrow suppression and other hematologic abnormalities. Although thrombotic thrombocytopenic purpura (TTP) has been reported with clopidogrel (Bennett et al., 2000), its occurrence (11 cases per 3 million patients treated) is rare, and has not been reported in randomized clinical trials performed to date.
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Conference papers on the topic "Oral P2Y12 inhibitor"

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Khan, Nazish, Joe Martins, Ben Wrigley, Saib Khogali, Shahzad Munir, Andrew Smallwood, Peter Nightingale, and James Cotton. "11 Oral P2Y12 inhibitors and stemi outcomes: a single centre propensity scored analysis." In British Cardiovascular Society Annual Conference ‘High Performing Teams’, 4–6 June 2018, Manchester, UK. BMJ Publishing Group Ltd and British Cardiovascular Society, 2018. http://dx.doi.org/10.1136/heartjnl-2018-bcs.11.

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