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Статті в журналах з теми "Triple antithrombotic therapy"

Автор: Grafiati

Опубліковано: 10 березня 2023

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1

Mega, Jessica, and Edward T. Carreras. "Antithrombotic therapy: triple therapy or triple threat?" Hematology 2012, no. 1 (December 8, 2012): 547–52. http://dx.doi.org/10.1182/asheducation.v2012.1.547.3798919.

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Abstract Antithrombotic therapy plays an essential role in the management of some of the most common and morbid medical conditions. Triple oral antithrombotic therapy (TOAT) is defined as the administration of both therapeutic oral anticoagulation (OAC) and dual antiplatelet therapy (DAPT) to patients with indications for both treatments. The current societal guidelines regarding TOAT are derived from observational studies and some trials of the use of warfarin in addition to antiplatelet therapy in patients with atrial fibrillation and a recent acute coronary syndrome or percutaneous coronary intervention. The general apprehension to administer TOAT is due to the heightened concern for bleeding, rendering warfarin's pharmacokinetic properties concerning. Newer anticoagulant agents may serve as appealing alternatives, and further investigations are warranted. The results of the recent trials that have studied the use of these agents in atrial fibrillation and acute coronary syndrome offer some useful applications to TOAT. Ultimately, selecting the most favorable antithrombotic strategy is going to involve weighing the risks and benefits for each patient.

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2

Nouri, Shayan Nabavi, and Brian L. Block. "Triple Oral Antithrombotic Therapy." JAMA Internal Medicine 176, no. 10 (October 1, 2016): 1433. http://dx.doi.org/10.1001/jamainternmed.2016.4415.

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3

Verheugt, Freek W. A. "Triple Antithrombotic Therapy After Coronary Stenting." Circulation: Cardiovascular Interventions 4, no. 5 (October 2011): 410–12. http://dx.doi.org/10.1161/circinterventions.111.965210.

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4

Han, Seongwook, Sola Han, Sung-Won Jang, Myung-Yong Lee, Young-Keun On, Oh Young Bang, Ji-Min Lee, et al. "Treatment Pattern of Antithrombotic Therapy over Time after Percutaneous Coronary Intervention in Patients with Atrial Fibrillation in Real-World Practice in Korea." Healthcare 9, no. 9 (September 9, 2021): 1185. http://dx.doi.org/10.3390/healthcare9091185.

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We examined antithrombotic treatment patterns with clinical characteristics and therapy changes over time in patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). Using the Health Insurance Review and Assessment service claims database (01JAN2007-30NOV2016) in Korea, we included adult patients with AF and PCI: (1) who underwent PCI with stenting between 01JAN2008 and 30NOV2016; (2) with ≥1 claim for AF (ICD code: I48) (3) with antithrombotics 1 day prior to or at the date of PCI; and (4) with CHADS2-VASc of ≥2. In this study, 7749 patients with AF who underwent PCI, triple therapy, dual therapy, dual antiplatelet therapy (DAPT), and single antiplatelet therapy were prescribed to 24.6%, 3.4%, 60.8%, and 11.0%, respectively. In the triple therapy group, 23.1% persisted with triple therapy for 12 months, whereas the remaining patients switched to a different therapy. In the entire cohort and several subgroups, the median treatment duration of triple therapy was 55–87 days. DAPT use for 12 months was the most common treatment pattern (62.6%) in the DAPT group (median treatment duration, 324–345 days). A significant discrepancy exists between the current guidelines and real-world practice regarding antithrombotic treatment with PCI for patients with AF. Appropriate use of anticoagulants should be emphasized.

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5

Aloia, Elio, Paolo Orselli, and Carlotta Sciaccaluga. "Triple Antithrombotic Therapy vs. Double Antithrombotic Therapy: One Scenario, 8 Questions, Many Conclusions." Current Cardiology Reviews 15, no. 3 (May 6, 2019): 219–23. http://dx.doi.org/10.2174/1573403x15666190111095438.

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In patients with atrial fibrillation undergoing percutaneous coronary intervention with the placement of stents, a triple antithrombotic therapy is empirically established, which consists of a combination of dual antithrombotic therapy (aspirin plus a P2Y12 inhibitor) and an oral anticoagulant agent. This choice is guided by the desirable result of reducing cerebrovascular and coronary ischemic events. However, there is an unwelcome outcome: an increased incidence of bleeding. On this matter, in 2018, a North American Perspective Update was published, about a year later it was followed by the publication of the European focus update on the dual antiplatelet therapy. After analysing the main differences between these two consensus documents, this review aims at examining the major studies on which they are based on, as a starting point to define the foundation of new trials that can help shed light on this prominent topic.

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6

Sulaica, Elisabeth M., Matthew A. Wanat, and Tracy E. Macaulay. "Clinical Considerations Prior to Transition From Triple Antithrombotic Therapy to Dual Antithrombotic Therapy." JAMA Cardiology 5, no. 1 (January 1, 2020): 111. http://dx.doi.org/10.1001/jamacardio.2019.4542.

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7

Turaga, Naga Sai Shravan, Danish Abbasi, Tanya Sharma, and Barry Uretsky. "DOUBLE TROUBLE MANAGED WITH TRIPLE ANTITHROMBOTIC THERAPY." Journal of the American College of Cardiology 77, no. 18 (May 2021): 2420. http://dx.doi.org/10.1016/s0735-1097(21)03775-x.

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8

Fukaya, Hidehira, and Junya Ako. "Triple Antithrombotic Therapy – Always One Too Many? –." Circulation Journal 80, no. 2 (2016): 316–17. http://dx.doi.org/10.1253/circj.cj-15-1360.

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9

Sørensen, Rikke, and Gunnar Gislason. "Triple Antithrombotic Therapy: Risky but Sometimes Necessary." Revista Española de Cardiología (English Edition) 67, no. 3 (March 2014): 171–75. http://dx.doi.org/10.1016/j.rec.2013.08.010.

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10

Aytürk, Mehmet, Hamza Sunman, and Ekrem Yeter. "A Persisting Dilemma for Triple Antithrombotic Therapy." Journal of the American College of Cardiology 64, no. 2 (July 2014): 231. http://dx.doi.org/10.1016/j.jacc.2013.10.089.

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11

Kovalchuk, E. Yu, A. S. Povzun, V. A. Kostenko, and A. V. Brega. "Acute coronary syndrome in a patient with transient ischemic attack: challenges of antithrombotic therapy (a clinical case)." Neurology, Neuropsychiatry, Psychosomatics 11, no. 4 (December 8, 2019): 156–59. http://dx.doi.org/10.14412/2074-2711-2019-4-156-159.

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The paper presents experience with antithrombotic therapy in a critically ill patient with acute coronary syndrome and transient ischemic attack. It characterizes problems in triple antithrombotic therapy in a very ill patient with comorbidity. The paper demonstrates an incremental approach to choosing therapy according to the clinical picture of disease, an assessment of risk factors for ischemic and hemorrhagic complications over time, which is very important in the routine practice of a physician. It also shows how, based on existing recommendations, the optimal anticoagulant is chosen as part of triple and double antithrombotic therapy in terms of its potential risks and possible complications.

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12

Alshibani, Mohannad. "Novel Approach of Antithrombotic Potency Amongst Patients Admitted to Hospital with Bleeding Using HEMORR2HAGES Score: A Retrospective Cohort Study." Heart Surgery Forum 22, no. 5 (September 4, 2019): E360—E365. http://dx.doi.org/10.1532/hsf.2645.

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Background: The purpose of this study was to evaluate whether a relationship exists between baseline HEMORR2HAGES score and antithrombotic potency amongst patients presenting with bleeding complication. We hypothesized that the more antithrombotic regimen potency, the less HEMORR2HAGES score you have. Methods: This is a retrospective observational study of patients admitted with a diagnosis of active bleeding between November 1, 2013 and August 31, 2015. The antithrombotic groups included patients on the following regimens: single antiplatelet therapy (SAP), single oral anticoagulant therapy (SOAC), dual antiplatelet therapy (DAPT), dual combination (SOAC+SAP), and triple antithrombotic therapy. The primary outcome was to review the mean HEMORR2HAGES score among the various groups. Results: There were a total of 180 patients in the study. No significant difference was noted among the five groups in the HEMORR2HAGES score (P = .36). The highest HEMORR2HAGES score was in the SAP group (3.23 ± 1.1). The lowest HEMORR2HAGES score was in the DAPT group (2.59 ± 1.2). In the Sub Group analysis, we compared single versus dual versus triple therapy, and we found the lowest HEMORR2HAGES score in the triple therapy group (2.70 ± 1.6); (P = .29). Conclusions: Among patients admitted with active bleeding, the HEMORR2HAGES score did not differentiate antithrombotic potency amongst groups with various regimens. This study highlights the necessity to evaluate antithrombotic therapy according to benefits and harms.

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13

Harskamp, Ralf E., John H. Alexander, and Renato D. Lopes. "Clinical Considerations Prior to Transition From Triple Antithrombotic Therapy to Dual Antithrombotic Therapy—Reply." JAMA Cardiology 5, no. 1 (January 1, 2020): 111. http://dx.doi.org/10.1001/jamacardio.2019.4551.

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14

Lin, Chenyu, Karlyn A. Martin, Mei Wang, Brady L. Stein, and Kush R. Desai. "Long-term antithrombotic therapy after venous stent placement." Phlebology: The Journal of Venous Disease 35, no. 6 (December 10, 2019): 402–8. http://dx.doi.org/10.1177/0268355519893819.

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Objectives To examine the prescribing patterns and outcomes of antithrombotic regimens after venous stent placement. Methods A total of 87 patients who received inferior vena cava or iliofemoral venous stents were included in the study. A retrospective review was performed to determine the antithrombotic regimens and the subsequent rates of in-stent restenosis, stent thrombosis, and bleeding. Results The prescribing patterns of specific antithrombotic regimens were highly variable. In-stent restenosis and stent thrombosis events were observed in 13 of 63 patients (21%) with available follow-up imaging, while major bleeding events were noted in 6 of 87 patients (7%). Triple therapy appeared to reduce the odds of in-stent restenosis/ stent thrombosis when compared to dual antiplatelet therapy (OR = 0.07, P = 0.01). Conclusions Substantial variability exists in antithrombotic therapy following venous stenting at our institution. This study demonstrated a reduction of in-stent restenosis/thrombosis events when utilizing triple therapy compared to antiplatelet-only regimens. However, larger prospective trials are needed to more accurately determine the relative risks and benefits of each antithrombotic regimen.

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15

Gallagher, Sean, and R. Andrew Archbold. "Percutaneous Coronary Intervention in Patients Who Have an Indication for Oral Anticoagulation – an Evidence-based Approach to Antithrombotic Therapy." Interventional Cardiology Review 10, no. 1 (2015): 16. http://dx.doi.org/10.15420/icr.2015.10.1.16.

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Dual antiplatelet therapy (DAPT) is required following percutaneous coronary intervention (PCI) to prevent stent thrombosis. The optimal antithrombotic therapy following PCI for patients with an indication for long-term oral anticoagulation (OAC) is uncertain. DAPT and OAC, a combination known as ‘triple therapy’, reduces cardiovascular event rates but is associated with a substantial risk of bleeding. Recent data suggest that the duration of DAPT (and thereby triple therapy in those who also require OAC) can be limited to 1–3 months following newgeneration drug-eluting stent deployment, and that aspirin may be omitted from triple therapy, without increasing the rate of ischaemic cardiovascular events. The increasing use of non-vitamin K antagonist oral anticoagulants and new antiplatelet agents (prasugrel and ticagrelor) has further complicated antithrombotic prescribing. This article aims to provide a summary of the evidence regarding antithrombotic therapy after PCI in patients who have an indication for OAC and to provide a framework to aid clinical decision-making in this area.

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16

Tan, Jiaoyan, Liangyi Si, Xiaorong Yang, and Jia Yue. "Dual and triple antithrombotic pharmacotherapy i n patients with coronary heart disease complicated with atrial fibrillation after percutaneous coronary intervention." Tropical Journal of Pharmaceutical Research 21, no. 12 (February 5, 2023): 2693–700. http://dx.doi.org/10.4314/tjpr.v21i12.26.

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Purpose: To compare the influence of triple antithrombotic therapy (warfarin + aspirin + clopidogrel) and dual antithrombotic therapy (aspirin + clopidogrel) on the risk of major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with atrial fibrillation (AF) after coronary stent implantation.Methods: A total of 210 patients with coronary heart disease and complicated with AF, who underwent percutaneous coronary intervention (PCI) in The Third Affiliated Hospital of Chongqing Medical University, were enrolled. They were divided into a triple antithrombotic therapy group (TT group) and a dual antithrombotic therapy group (DT group). The risks of hemorrhage and MACCEs were evaluated via follow-up and multivariate regression analysis.Results: Based on the classification criteria for bleeding in Thrombolysis in Myocardial Infarction (TIMI) and Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO), there were 6 and 0 patients with significant hemorrhage in TT and DT groups, respectively, during the one year of follow-up (p = 0.013). The total number of MACCEs of 52 and 61 for both groups was not significantly different (p = 0.213). Moreover, the results of multivariate Cox regression analysis revealed that the histories of ischemia and stroke (p = 0.023), heart failure (p = 0.007), and high CHA2DS2-VASc score (p = 0.004) were the risk factors for MACCEs.Conclusion: Compared with dual antithrombotic therapy, triple antithrombotic therapy increases the risk of major hemorrhage in AF patients after PCI, but does not noticeably reduce the incidence of MACCEs during one year of follow-up.

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17

Barbarash, O. L., and V. V. Kashtalap. "Current management approaches to patients with atrial fibrillation and percutaneous coronary intervention." Medical alphabet 2, no. 30 (November 16, 2019): 12–17. http://dx.doi.org/10.33667/2078-5631-2019-2-30(405)-12-17.

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In this review are provided relevant positions of the American and European clinical guidelines for antithrombotic therapy in the patients with a combination of atrial fibrillation and coronary heart disease with percutaneous coronary intervention. Similarities and distinctions of positions of two expert communities were discussed. In addition, the evidence-based positions concerning the choice of the optimal antithrombotic therapy are noted. Primary positions of a clopidogrel when choosing the antiagregants for double or triple antithrombotic therapy were designated.

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18

Gurbel, Paul A., and Udaya S. Tantry. "Triple Antithrombotic Therapy With Prasugrel in the Stented Patient." Journal of the American College of Cardiology 61, no. 20 (May 2013): 2067–69. http://dx.doi.org/10.1016/j.jacc.2013.02.032.

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19

Steffel, J., and T. F. Lüscher. "Individualized antithrombotic therapy." Hämostaseologie 36, no. 01 (2016): 26–32. http://dx.doi.org/10.5482/hamo-14-12-0080.

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SummaryClot formation in the circulation is a physiological mechanism preventing bleeding at sites of loss of vascular integrity. Clot formation may also occur intravascularly under pathological conditions, e. g. leading to myocardial infarction, stroke, and critical limb ischaemia. Clot formation involves activation of the coagulation cascade and of platelets eventually leading to an occlusive clot. In the venous circulation, clots are rich in erythrocytes and fibrin, while in the arterial circulation platelets predominate. Accordingly, drugs have been developed to interfere with the activation of the coagulation and/or platelets. As several coagulation factors such as factor VII, VIIII, X and thrombin (factor II) are vitamin K-dependent, drugs interfering with the effects of the vitamin (VKAs), i. e. warfarin, marcoumar or sintrom have been used for decades to prevent thromboembolism and embolic stroke. With the advent of selective inhibitors of factor X (apixaban, edoxaban and rivaroxaban) or factor II (dabigratan) the therapeutic spectrum of anti-thrombotic therapy has been expanded. On the other hand, platelet inhibitors such as aspirin and thienopyridines, i.e. clopidogrel, prasugrel, and ticagrelor have extensively been used to treat arterial disease in the coronary, cerebrovascular and peripheral circulation. Individualized antithrombotic therapy considers (1) characteristics of the disease and (2) those of the patient. Such a decision tree first separates “arterial” and “venous” thrombi. For the prevention of arterial thrombi that occur in acute myocardial infarction and certain forms of stroke and critical limb ischemia, platelet inhibitors are indicated. The first line drug is aspirin which interferes with thromboxane A2 (TXA2) formation and partially inhibits platelet activation. In patients receiving a stent or in acute coronary syndromes (ACS), the combination of aspirin with a thienopyri-dine is indicated. On the other hand, patients with venous clots should be treated with anticoagulants interfering with the activation of the coagulation cascade. While the longest experiences exist with vitamin K antagonists, the novel oral anticoagulants (NOACs) are at least as effective, but associated with less intracerebral and life-threatening bleeding. VKAs remain the treatment of choice in patients receiving artificial heart valves or with renal failure (in general a GFR of 30 ml/min/KG or less). In the remaining patients, current evidence suggests that NOACs should be preferred. The NOACs are well documented in patients with thromboembolism and atrial fibrillation. Whether patients with an acute ACS should receive dual antiplatelet drugs plus a low dose NOAC is a matter of debate, although conceptually it is an attractive concept. In patients after stent implantation with atrial fibrillation, in which a triple therapy with dual antiplatelet drugs and an anticoagulant is indicated, bleeding is an issue. Recent data suggest that administering a thienopyridine plus warfarin (or possibly a NOAC), while at the same time skipping aspirin may be an alternative to avoid severe bleeding and to maintain antithrombotic efficacy. Conclusion: An extensive therapeutic arsenal to interfere with clot formation requires an individualized approach considering the disease condition and co-morbidities of the patient, the anticoagulants’ and patient characteristics. This review builds on and extends previous publications of the authors on this topic.

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20

Wernly, Bernhard, Michael Lichtenauer, David Erlinge, and Christian Jung. "Antithrombotic therapy in atrial fibrillation: stop triple therapy and start optimizing dual therapy?" Clinical Research in Cardiology 109, no. 1 (May 29, 2019): 128–30. http://dx.doi.org/10.1007/s00392-019-01496-w.

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21

Dharma, Surya. "Double Antithrombotic versus Triple Antithrombotic Therapy in Patients with Atrial Fibrillation and Acute Coronary Syndrome." International Journal of Angiology 29, no. 02 (March 21, 2020): 081–87. http://dx.doi.org/10.1055/s-0040-1702208.

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AbstractIn atrial fibrillation (AF), oral anticoagulant (OAC) therapy with either vitamin K antagonist or non–vitamin K antagonist is used to prevent thromboembolic complications. In patients who presented with acute coronary syndrome (ACS) and were treated by percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor reduces major adverse cardiac events (MACEs) and stent thrombosis. Consequently, in patients with AF who presented with ACS and were treated by PCI, the combination of OAC and DAPT, the so-called triple antithrombotic therapy (TAT) is needed to improve the outcome of the patients. However, the use of TAT increases the risk of bleeding. Several randomized clinical trials and a meta-analysis evaluated the use of TAT and double antithrombotic therapy (DAT) in this population, and DAT is defined as patients who receive combination of one antiplatelet and OAC. In general, the studies demonstrated a reduction in bleeding event in patients who received DAT as compared with TAT, with similar incidence of thromboembolic complications and MACE. To date, there is no established consensus or guideline for the most appropriate combination of antithrombotic agents in patients with AF and ACS who undergo PCI. Tailoring the treatment for each individual is likely the best approach to determine the balance of bleeding risk and ischemic events before starting antithrombotic therapy. Future trials with adequate sample size are needed to find the most appropriate combination of antiplatelet and OAC in patients with AF who presented with ACS and treated by PCI.

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22

Eyileten, Ceren, Marek Postula, Daniel Jakubik, Aurel Toma, Dagmara Mirowska-Guzel, Giuseppe Patti, Giulia Renda, and Jolanta M. Siller-Matula. "Non-Vitamin K Oral Anticoagulants (NOAC) versus Vitamin K Antagonists (VKA) for Atrial Fibrillation with Elective or Urgent Percutaneous Coronary Intervention: A Meta-Analysis with a Particular Focus on Combination Type." Journal of Clinical Medicine 9, no. 4 (April 14, 2020): 1120. http://dx.doi.org/10.3390/jcm9041120.

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Background: Our study aims to perform a meta-analysis of benefits and risks associated with the use of non-vitamin K oral anticoagulants (NOAC) versus vitamin K antagonists (VKA) in patients with a percutaneous coronary intervention (PCI) with a particular focus on the combination type: dual vs. dual antithrombotic therapy (DAT: NOAC + single antiplatelet therapy (SAPT) vs. DAT: VKA + SAPT), dual vs. triple antithrombotic therapy (DAT: NOAC + SAPT vs. TAT: VKA + dual antiplatelet therapy (DAPT)) or triple vs. triple antithrombotic therapy (TAT: NOAC+DAPT vs. TAT: VKA+DAPT). Methods: PubMed, EMBASE, and Cochrane databases were searched to identify randomized controlled trials comparing antithrombotic regimens. Four randomized studies (n = 10.969; PIONEER AF-PCI, RE-DUAL PCI, AUGUSTUS, and ENTRUST-AF PCI) were included. The primary outcome was the composite of major bleeding defined by the International Society on Thrombosis and Hemostasis (ISTH) and clinically relevant bleeding requiring medical intervention (CRNM). Secondary outcomes included all-cause mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), stroke, and stent thrombosis (ST). Results: Combination strategies with NOACs were associated with reduced risk of major bleeding events across different combination strategies as compared to VKA, with the most significant risk reduction when DAT was compared with TAT, namely DAT with NOAC + SAPT was associated with a 37% relative risk reduction (RRR) of major bleeding events as compared to TAT with VKA + DAPT (RR 0.63; 95% CI, 0.50–0.80). The reduction of major bleeding risks is a class effect of NOACs. Combination strategies of NOACs vs. VKAs resulted in a comparable risk of MACE, MI, stroke, ST, or death. Conclusions: Antithrombotic combinations of NOACs (as DAT or TAT) are safer than VKAs with respect to bleeding risk and result in a satisfactory efficacy with no increase of ischemic or thrombotic events in patients undergoing PCI.

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23

Greco, Cesare. "Triple antithrombotic therapy, including NAO, in patients after coronary stenting." Journal of Cardiovascular Medicine 18 (January 2017): e125-e128. http://dx.doi.org/10.2459/jcm.0000000000000472.

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24

Capranzano, Piera. "The sunset of triple antithrombotic therapy for atrial fibrillation patients." European Heart Journal Supplements 21, Supplement_B (March 1, 2019): B36—B37. http://dx.doi.org/10.1093/eurheartj/suz013.

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25

Moser, M., C. B. Olivier, and C. Bode. "Triple antithrombotic therapy in cardiac patients: more questions than answers." European Heart Journal 35, no. 4 (December 2, 2013): 216–23. http://dx.doi.org/10.1093/eurheartj/eht461.

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26

Savonitto, Stefano, Marco Ferri, and Elena Corrada. "Fatal Bleedings With Prasugrel as Part of Triple Antithrombotic Therapy." Revista Española de Cardiología (English Edition) 67, no. 3 (March 2014): 225–26. http://dx.doi.org/10.1016/j.rec.2013.06.014.

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27

Del Castillo, Roberto, Adriana De la Rosa Riestra, Ester Canovas Rodriguez, Alfonso Freites Esteves, Javier Alonso Bello, Pablo Salinas, Lorenzo Hernando Marrupe, and Javier Botas Rodriguez. "TCT-337 Triple Antithrombotic Therapy After PCI:4-years FU." Journal of the American College of Cardiology 62, no. 18 (October 2013): B107. http://dx.doi.org/10.1016/j.jacc.2013.08.1074.

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28

Potter, Brian J., and Alexandra Bastiany. "Triple Antithrombotic Therapy Following Anterior ST-Segment Elevation Myocardial Infarction." JACC: Cardiovascular Interventions 8, no. 7 (June 2015): 1002–3. http://dx.doi.org/10.1016/j.jcin.2015.03.013.

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29

Capodanno, Davide, and Dominick J. Angiolillo. "Triple Antithrombotic Therapy at the Intercept Between Threats and Opportunities." JACC: Cardiovascular Interventions 10, no. 11 (June 2017): 1086–88. http://dx.doi.org/10.1016/j.jcin.2017.03.028.

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30

Faza, Nadeen N., Amgad Mentias, Akhil Parashar, Pulkit Chaudhury, Amr F. Barakat, Shikhar Agarwal, Siddharth Wayangankar, Stephen G. Ellis, E. Murat Tuzcu, and Samir R. Kapadia. "Bleeding complications of triple antithrombotic therapy after percutaneous coronary interventions." Catheterization and Cardiovascular Interventions 89, no. 2 (May 24, 2016): E64—E74. http://dx.doi.org/10.1002/ccd.26574.

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31

DEACONU, Alexandru, Silvia DEACONU, Andreea GATEJ, and Maria DOROBANTU. "Triple Antithrombotic Therapy in Patients with Acute Coronary Syndrome and Atrial Fibrillation – Balancing Risks and Benefits." Medicina Moderna - Modern Medicine 28, no. 1 (March 29, 2021): 63–69. http://dx.doi.org/10.31689/rmm.2021.28.1.63.

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Optimal antithrombotic therapy in patients with AF who undergo coronary stenting for an ACS has been a subject of constant change, with the addition of numerous trials in recent years. Objectives: The aim of our study was to assess current antithrombotic treatment in patients with AF and ACS treated with PCI. Material and methods: We performed a observational retrospective study on patients with nonvalvular AF, ACS and PCI between January 2017 and May 2019. We assessed both ischemic risk (IR) and haemorrhagic risk (HR) according to the 2018 ESC guidelines strategies. Results: 184 patients with nonvalvular AF and ACS treated with PCI were eligible for inclusion. In the whole cohort the HR was significantly higher than the IR (3.66+/-1.15 respectively 2.84+/-1.15, p < 0.001). NSTEMI carries both the highest IR and HR (p<0.05). The majority of patients (88.04%) received triple antithrombotic therapy mostly for one month (39%). Main drug combination used was Aspirin, Clopidogrel, antivitamin K (48.48%). Conclusions: In our registry of AF patients with ACS treated with PCI, triple antithrombotic therapy is still the strategy of choice with an initial duration of one month. In our cohort, HR is higher than IR, NSTEMI carrying the highest risks out of all the ACS.

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Verlinden, Nathan J., James C. Coons, Carlo J. Iasella, and Sandra L. Kane-Gill. "Triple Antithrombotic Therapy With Aspirin, P2Y12 Inhibitor, and Warfarin After Percutaneous Coronary Intervention." Journal of Cardiovascular Pharmacology and Therapeutics 22, no. 6 (March 9, 2017): 546–51. http://dx.doi.org/10.1177/1074248417698042.

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Background: Triple antithrombotic therapy is used in patients who require systemic anticoagulation and undergo percutaneous coronary intervention (PCI) requiring dual antiplatelet therapy. Bleeding with this combination is significant; however, few studies have described outcomes with the use of newer oral P2Y12 inhibitors in this setting. Objectives: We aimed to compare outcomes among patients prescribed triple therapy with prasugrel or ticagrelor compared to triple therapy with clopidogrel in patients who underwent PCI and required warfarin. Methods: We retrospectively evaluated 168 patients who received either prasugrel (n = 32) or ticagrelor (n = 10) and were matched (1:3) to those who received clopidogrel (n = 126) at the time of discharge from the index PCI visit. Matching was performed based on age ±10 years, sex, and indication for PCI. The primary outcome was the incidence of any bleeding during the 12-month follow-up. We also evaluated major adverse cardiovascular and cerebrovascular events (MACCEs). Results: Patient baseline characteristics were similar between groups. There was a significant excess of bleeding in patients who received prasugrel or ticagrelor compared to clopidogrel as part of triple therapy (28.6% vs 12.7%; odds ratio, 3.3; 95% confidence interval, 1.38-8.34). No differences were seen between groups in MACCEs. Conclusions: The use of prasugrel or ticagrelor as part of triple antithrombotic therapy among patients who underwent PCI and received warfarin was associated with significantly more bleeding compared to patients who received clopidogrel. Therefore, higher potency P2Y12 inhibitors should be used cautiously in these patients.

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Asencio, Luis Alejandro, Jennifer J. Huang, and Joseph S. Alpert. "Combining Antiplatelet and Antithrombotic Therapy (Triple Therapy): What Are the Risks and Benefits?" American Journal of Medicine 127, no. 7 (July 2014): 579–85. http://dx.doi.org/10.1016/j.amjmed.2014.02.030.

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Lin, Chenyu, Karlyn A. Martin, Mei Wang, Brady L. Stein, and Kush R. Desai. "Long-Term Antithrombotic Therapy after Venous Stent Placement." Blood 132, Supplement 1 (November 29, 2018): 1249. http://dx.doi.org/10.1182/blood-2018-99-111069.

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Abstract Introduction Chronic deep venous insufficiency (CVI) is a common disorder of the venous valves which can cause many debilitating symptoms including edema, pain, and skin changes. CVI may result from a primary non-thrombotic cause, such as May-Thurner syndrome (MTS) or extrinsic compression from a pelvic mass, or as the sequelae of an acute deep vein thrombosis (DVT). Endovascular interventions, including percutaneous transluminal angioplasty and venous stent placement, have been increasingly utilized as a minimally-invasive treatment option for CVI. In patients treated via endovascular therapy, stent restenosis is a significant area of clinical concern. However, there is a paucity of data on the optimal preventative long-term antithrombotic strategy. Current practice is highly variable and employs a combination of anticoagulation and antiplatelet agents, which borrows heavily from experience with venous thromboembolism and arterial stent management, respectively. This study examines the prescribing patterns and outcomes of various antithrombotic regimens after venous stent placement at a large academic medical center. Methods Patients who received venous stents at our institution between January 1st, 2010 and December 31st, 2015 were eligible for the study. A retrospective review was performed to determine the antithrombotic regimens and the rates of stent restenosis and major bleeding within two years of stent placement. The relationship between these outcomes and antithrombotic regimens was analyzed via logistic regression. Additional logistic regression and linear regression models were used to evaluate the impact of indications and hypercoagulable risk factors on the selection of antithrombotic agents. Results A total of 151 patients were included in the study (Table 1). Antithrombotic regimens were variable: 58 patients (38%) received triple therapy (i.e., anticoagulation plus dual antiplatelet therapy), 25 (17%) received anticoagulation only, 21 (14%) received anticoagulation plus a single antiplatelet agent, 15 (10%) received dual antiplatelet therapy only, 10 (7%) received a single antiplatelet, and 22 (15%) received no antithrombotic therapy (Figure 1). Patients with acute DVTs with or without MTS were more frequently given multiple antithrombotic agents compared to those with extrinsic compression. The duration of antithrombotic therapy was also variable. When anticoagulation was prescribed (n = 104), 31% received indefinite therapy, followed by 22% for 6 months and 12% for 3 months. Patients with a history of prior DVTs or thrombophilia were more likely to be prescribed indefinite anticoagulation. Aspirin was most commonly prescribed for an indefinite duration (62 of 88 patients) while clopidogrel was most commonly prescribed for just 3 months (60 of 89 patients). Twenty-three patients (15%) developed stent restenosis. Triple antithrombotic therapy had significantly lower rates of stent restenosis compared to no antithrombotic therapy (OR = 0.05, p < 0.01), and was associated with lower rates of restenosis compared to anticoagulation alone (OR = 0.19, p = 0.07) and dual antiplatelet therapy (OR = 0.25, p = 0.09). Anticoagulation with a single antiplatelet agent also led to lower rates of stent restenosis when compared to no antithrombotic therapy (OR = 0.08, p = 0.04). Medication non-compliance and antiphospholipid antibody syndrome were identified as independent predictors of stent restenosis (OR = 8.84, p = 0.01 and OR = 7.11, p = 0.03, respectively). Major bleeding was observed in 11 patients (7%). Of note, there were no major bleeding events observed in the dual antiplatelet or single antiplatelet groups, which were thus excluded from the regression model. Among the remaining treatment groups, there was no significant difference in major bleeding rates. Conclusions This study emphasizes the considerable variability in the prescribing patterns of long-term antithrombotic therapy after venous stent placement. There appears to be benefit to antithrombotic therapy in preventing stent restenosis, particularly when anticoagulation is combined with antiplatelet agents. However, this may be counterbalanced by an increased risk of bleeding. Larger prospective trials are needed to evaluate the relative risks and benefits of each antithrombotic regimen, and ultimately determine the optimal management strategy, following venous stent placement. Disclosures Desai: Philips/Spectranetics: Other: consulting; Cook Medical: Other: consulting, Speakers Bureau; Boston Scientific: Other: consulting, Speakers Bureau; AngioDynamics: Other: consulting, Speakers Bureau; OptiMed: Other: consulting.

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Sycheva, N. A., L. Yu Koroleva, V. P. Nosov, G. V. Kovaleva, N. N. Paikova, A. T. Volkova, and A. M. Kisel. "Efficacy and safety of new oral anticoagulants as part of triple antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome. Data from an observational study." Kardiologiia 60, no. 7 (June 19, 2020): 53–63. http://dx.doi.org/10.18087/cardio.2020.7.n954.

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Aim To study efficacy and safety of a triple antithrombotic therapy with direct oral anticoagulants (DOAC) versus warfarin in patients with atrial fibrillation after acute coronary syndrome, for 12 months following discharge from the hospital.Materials and methods This single-site cohort, prospective, observational study performed at the Regional Vascular Center 2 of the N.A. Semashko Nizhniy Novgorod Regional Clinical Hospital included 402 patients. It was possible to maintain contacts with 206 patients for 12 months. These patients were divided into two groups, the DOAC treatment (n=105) and the warfarin treatment (n=101) as a part of triple antithrombotic therapy upon discharge. Clinical observation was performed at 1, 3, 6, and 12 months after the discharge by structured telephone interview. Predetermined efficacy endpoints included cardiovascular death, myocardial infarction, stent thrombosis, and ischemic stroke. Safety endpoints included bleeding defined as small, medium (clinically significant), and major in accordance with the TIMI classification.Results At 12 months of follow-up, 80 patients (76.19%) continued taking DOAC and 39 patients (38.61%, p<0.001) continued taking warfarin; in this process, only 25 patients (24.75%) monitored their INR on a regular basis. With a regular INR monitoring and TTR >70%, death rate did not differ in the warfarin and the DOAC treatment groups. However, there was a difference in reaching the composite efficacy endpoint (p=0.048): ischemic events occurred statistically significantly more frequently in the warfarin treatment group than in the DOAC treatment group.Conclusions In 12 months after discharge from the hospital, compliance with the DOAC treatment as a part of the antithrombotic therapy was significantly higher than compliance with the warfarin treatment. The triple antithrombotic therapy with DOAC was safer than the warfarin treatment by the number of hemorrhagic complications and more effective in prevention of ischemic events, primarily due to no need for monitoring of lab test values.

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Owen, Andrew. "Antithrombotic treatments for patients with atrial fibrillation and a requirement for a coronary artery stent." International Cardiovascular Forum Journal 1, no. 1 (March 29, 2015): 5. http://dx.doi.org/10.17987/icfj.v1i1.7.

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<p><span>Background: </span>Patients with atrial fibrillation and a coronary artery stent require anticoagulation to provide prophylaxis</p><p>against stroke and dual antiplatelet therapy to provide prophylaxis against stent thrombosis (triple therapy).</p><p>This combination increases the risk of major bleeding complications compared to either treatment alone. It is</p><p>suggested that an alternative to triple therapy is high dose dual antiplatelet therapy (aspirin 325mg/day and</p><p>clopidogrel 75 mg/day), which would have similar efficacy to triple therapy in relation to prophylaxis against</p><p>both stroke and stent thrombosis with a lower risk of bleeding complications.</p><p><span>Summary: </span>1. Patients with atrial fibrillation and a coronary artery stent require triple therapy, which is associated with</p><p>increased bleeding risk.</p><p>2. In everyday practice 50% of patients do not receive this, because of the excess bleeding risk.</p><p>3. It is suggested that for patients at increased bleeding risk and for whom it is felt that triple therapy is not</p><p>suitable, Aspirin (325mg daily) and clopidogrel (75mg daily) should be considered.</p><p> </p>

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Campo, Gianluca, and Giulia Bugani. "The patient with atrial fibrillation undergoing percutaneous angioplasty: triple therapy or new therapeutic strategies?" AboutOpen 4, no. 1 (September 14, 2018): 116–21. http://dx.doi.org/10.19156/abtpn.2018.0056.

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The management of antithrombotic therapy in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is a challenge cardiologists face daily. The main difficulty is represented by finding the right balance between the prevention of thrombotic risk and the inevitable increase in bleeding. Most guidelines recommend the use of both oral anticoagulants and dual antiplatelet therapy in combination (triple therapy) in patients with FA undergoing PCI, suggesting however immediate use of dual antithrombotic therapy in patients with prevalent bleeding risk. Many studies show that triple therapy is associated with high frequency of major bleeding, thus stimulating the research for new therapeutic strategies. We report the case of a patient suffering from hypertension, dyslipidemia and epistaxis, hospitalized for the onset of angina associated with moderate efforts. Despite scientific evidence to support the use of dual therapy with dabigatran, the patient's detailed clinical history shows that this type of approach has not yet entered into current clinical practice, although the final therapeutic choice is in line with the results of the RE-DUAL PC study (Cardiology).

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Wójcik, Sylwia, Katarzyna Mocny-Pachońska, Sophie Bisch-Wójcik, Agnieszka Balicz, and Tadeusz Morawiec. "Perioperative Management of Dental Surgery Patients Chronically Taking Antithrombotic Medications." International Journal of Environmental Research and Public Health 19, no. 23 (December 2, 2022): 16151. http://dx.doi.org/10.3390/ijerph192316151.

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The development of medicine is based not only on the introduction of new methods of treatment, but also on the use of increasingly effective drugs, including antithrombotic drugs. Drugs that inhibit the activity of platelets (antiplatelet and anti-aggregating drugs) and pharmaceuticals that inhibit the activity of plasma coagulation factors (anticoagulants) are used in antithrombotic therapy. In our daily practice we encounter patients who take chronic antiplatelet or anticoagulant drugs. However, more and more often we are dealing with patients who are treated with two antiplatelet drugs, an antiplatelet and an anticoagulant or even undergoing triple antithrombotic therapy. When preparing the patient for invasive craniofacial procedures, it should be assessed whether the temporary discontinuation of antithrombotic treatment due to the fear of excessive perioperative bleeding is justified and will not result in life-threatening thromboembolic complications. The authors discuss in detail the medications used in modern antithrombotic treatment and present a perioperative management procedure with a patient who takes l4 z of these medications chronically.

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Wernly, Bernhard, Michael Lichtenauer, David Erlinge, and Christian Jung. "Correction to: Antithrombotic therapy in atrial fibrillation: stop triple therapy and start optimizing dual therapy?" Clinical Research in Cardiology 109, no. 1 (July 5, 2019): 131. http://dx.doi.org/10.1007/s00392-019-01510-1.

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Koracevic, Goran P., and Ivana Davinic. "Triple antithrombotic therapy ought to be reviewed in pulmonary thromboembolism guidelines." Journal of Critical Care 54 (December 2019): 274–75. http://dx.doi.org/10.1016/j.jcrc.2019.05.010.

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Fu, Angel, Kuljit Singh, Joseph Abunassar, Nikita Malhotra, Michel Le May, Marino Labinaz, Christopher Glover, et al. "Ticagrelor in Triple Antithrombotic Therapy: Predictors of Ischemic and Bleeding Complications." Clinical Cardiology 39, no. 1 (January 2016): 19–23. http://dx.doi.org/10.1002/clc.22486.

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Zimarino, M., G. Renda, and R. De Caterina. "Triple antithrombotic therapy with aspirin, clopidogrel and warfarin — a persisting dilemma." Internal and Emergency Medicine 2, no. 3 (October 2007): 163–64. http://dx.doi.org/10.1007/s11739-007-0054-6.

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Lai, Jennifer K., Katie L. Willenborg, Theodore Berei, and Anne E. Rose. "Antithrombotic selection in patients undergoing transcatheter aortic valve replacement." American Journal of Health-System Pharmacy 78, no. 1 (October 29, 2020): 22–35. http://dx.doi.org/10.1093/ajhp/zxaa329.

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Abstract Purpose Clinical controversy regarding the most appropriate antithrombotic regimen after transcatheter aortic valve replacement remains. Current evidence, guidelines, and recommendations are discussed. Summary Antithrombotic selection following transcatheter aortic valve replacement depends on a variety of patient-specific factors. For patients without a preexisting indication for anticoagulation, initial trials employed dual antiplatelet therapy as the postprocedural therapy of choice. Newer studies in this patient population, however, suggest single antiplatelet therapy reduces bleeding events without sacrificing ischemic protection. In patients with a preexisting indication for anticoagulation, warfarin plus single antiplatelet therapy, as opposed to triple antithrombotic therapy, offered similar ischemic protection while reducing clinically significant bleeding. Warfarin monotherapy was associated with a further reduction in bleeding events. One trial demonstrated the safety and efficacy of using apixaban in patients with concomitant atrial fibrillation; however, routine use of rivaroxaban increased adverse cardiac and bleeding events, leaving the utility of direct-acting oral anticoagulants in question. Conclusion Available evidence and current guidelines point to a lack of consensus regarding antithrombotic selection after transcatheter aortic valve replacement. Patient-specific factors and comorbidities must be considered when tailoring therapy, with an emphasis on balancing thrombotic and bleeding risks.

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Huber, Kurt, Gregory Lip, and Francisco Marín. "Antithrombotic therapy in atrial fibrillation and stent implantation: treatment or threats by the use of triple or dual antithrombotic therapy." Thrombosis and Haemostasis 110, no. 10 (2013): 623–25. http://dx.doi.org/10.1160/th13-08-0677.

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Eikelboom, John, Peter Berger, David Holmes, Deepak Bhatt, Richard Becker, Dominick Angiolill, David Faxon, and David Moliterno. "Consensus Document: Antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting." Thrombosis and Haemostasis 106, no. 10 (2011): 571–84. http://dx.doi.org/10.1160/th11-04-0262.

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SummaryThe optimal regimen of the anticoagulant and antiplatelet therapies in patients with atrial fibrillation who have had a coronary stent is unclear. It is well recognised that “triple therapy” with aspirin, clopidogrel, and warfarin is associated with an increased risk of bleeding. National guidelines have not made specific recommendations given the lack of adequate data. In choosing the best antithrombotic options for a patient, consideration needs to be given to the risks of stroke, stent thrombosis and major bleeding. This document describes these risks, provides specific recommendations concerning vascular access, stent choice, concomitant use of proton-pump inhibitors and the use and duration of triple therapy following stent placement based upon the risk assessment.

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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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Opincariu, Diana. "Triple Antithrombotic Therapy – Is It History or Should We Still Do It?" Journal of Interdisciplinary Medicine 4, no. 1 (March 1, 2019): 7–10. http://dx.doi.org/10.2478/jim-2019-0006.

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Pavlović, Milan, Vladimir Stojanović, Nebojša Krstić, Snežana Ćirić-Zdravković, Danijela Đorđević-Radojković, Miodrag Damjanović, Goran Koraćević, et al. "Triple antithrombotic therapy in patients with atrial fibrillation and coronary artery disease." Srce i krvni sudovi 33, no. 2 (2014): 162–65. http://dx.doi.org/10.5937/siks1402162p.

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Kerneis, Mathieu, Usama Talib, Tarek Nafee, Yazan Daaboul, Seyedmahdi Pahlavani, Anmol Pitliya, M. M. Furqan, et al. "Triple Antithrombotic Therapy for Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention." Progress in Cardiovascular Diseases 60, no. 4-5 (January 2018): 524–30. http://dx.doi.org/10.1016/j.pcad.2018.01.008.

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Paikin, Jeremy S., Douglas S. Wright, Mark A. Crowther, Shamir R. Mehta, and John W. Eikelboom. "Triple Antithrombotic Therapy in Patients With Atrial Fibrillation and Coronary Artery Stents." Circulation 121, no. 18 (May 11, 2010): 2067–70. http://dx.doi.org/10.1161/circulationaha.109.924944.

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