Dual antiplatelet therapy

Markus HS, Droste DW, Kaps M, Larrue V, Lees KR, Siebler M, Ringelstein EB. Dual antiplatelet therapy with clopidogrel and aspirin in s3miptomatic carotid stenosis evaluated using doppler embolic signal detection the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 2005 lll(17) 2233-2240. 

One of the significant factors promoting late stent thrombosis has been found to be premature discontinuation of dual antiplatelet therapy (aspirin and clopidrogel). In an analysis of 4,666 of patients undergoing initial PCI with BMS or DES, researchers from the Duke Heart center reported that longterm risk for death and major cardiac events was significantly increased among patients in the DES... 

Grines CL, Bonow RO, Casey DE, et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents a science advisory. J Am Coll Cardiol 2007 49 734-739. 

Lee S-W, Park S-W, Hong M-K, et al. Triple versus dual antiplatelet therapy after coronary stenting impact on stent thrombosis. J Am Coll Cardiol 2005 46 1833-1837. 

Despite the well-documented clinical efficacy of dual antiplatelet therapy of clopidogrel and aspirin, it has been... 

Cuisset T Frere C, Quilici J, et al, High post-treatment platelet reactivity identified low-responders to dual antiplatelet therapy at increased risk of recurrent cardiovascular events after stenting for acute coronary syndrome, J Thromb Haemost 2006 4 542-549. 

The most important safety concerns are the potential for perforation which could result in tamponade or compromise of collaterals which can result in infarction. In current PCI practice with its reliance on drug eluting stent (DES), dual antiplatelet therapy with aspirin (ASA) and a thienopyridine (usually clopidogrel) is standard. These should be used in all patients. Pre-procedure administration of the thienopyridine should be given, if possible. 

Patient selection is crucial in reducing rates of stent thrombosis. The SCAAR registry initially showed increased rates of stent thrombosis with DES however, as practice patterns changed, this increase disappeared and there was no difference in stent thrombosis between DES and BMS (38). Nevertheless, given these findings, the duration of dual antiplatelet therapy with clopidogrel and aspirin is recommended for at least 12 months. 

Substantial evidence supports the use of the thienopyridine clo-pidogrel in patients with UA/NSTEMI who are treated medically or who undergo PCI with stenting (67,68). Clopidogrel is also used, in combination with aspirin, following elective PCI with stenting (69). Information on the efficacy and safety of dual antiplatelet therapy with... 

The ATLAS ACS-TIMI 46 study was a phase n dose-escalation study of the use of rivaroxaban in preventing recurrent thrombosis in patients with acute coronary syndrome [48 ]. Patients who were taking aspirin as the sole antiplatelet therapy were randomized to either placebo or rivaroxaban 5,10, or 20 mg/day, while patients who were taking dual antiplatelet therapy took either placebo or rivaroxaban 5, 10, 15, or 20 mg/day. There was a dose-related increase in the risk of clinically significant... 

Zuem CS, Geisler T, Lutilsky N, Winter S, Schwab M, Gawaz M. Effect of comedication with proton pump inhibitors (PPIs) on post-interventional residual platelet aggregation in patients undergoing coronary stenting treated by dual antiplatelet therapy. Thromb Res 2010 125(2) e51-4. 

Tomaselh GF (2015) Introduction to a compendium on sudden cardiac death epidemiology, mechanisms, and management. Circ Res 116 1883-1886 Udell JA, Bonaca MP, Collet JP et al (2016) Long-term dual antiplatelet therapy for secondary prevention of cardiovascular events in the subgroup of patients with previous myocardial infarction a collaborative meta-analysis of randomized trials. Eur Heart J 37 390-399 Unudurthi SD, Hund TJ (2016) Late sodium current dysregulation as a causal factor in arrhythmia. Expert Rev Cardiovasc Ther 14 545-547... 

Aronow HD, Steinhubl SR, Brennan DM, Berger PB, Topol EJ. CREDO Investigators. Bleeding risk associated with 1 year of dual antiplatelet therapy after percutaneous coronary intervention insights from the Clopidogrel for the Reduction of Events During Observation (CREDO) trial. Am Heart J 2009 157(2) 369-74. 

Gremmel T, Steiner S, Seidinger D, Koppensteiner R, Panzer S, Kopp CW. Smoking promotes clopidogrel-mediated platelet inhibition in patients receiving dual antiplatelet therapy. Thromb Res 2009 124(5) 588-91. 

Nervous system Embolization of a spinal dural arteriovenous fistula with enbucrilate resulted in progressive venous congestion, which was treated with antithrombin therapy, and dual antiplatelet therapy and resolved after more than 2 months [42 ]. 

Ding XL, Xie C, Jiang B, Gao J, Zhang LL, Zhang H, et al. Efficacy and safety of adjunctive cilostazol to dual antiplatelet therapy after stent implantation an updated meta-analysis of randomized controlled trials. J Cardiovasc Pharma T May 2013 18(3) 222-8. 

Nowadays, drug therapy aims to prevent surface mediated platelet activation through at least 12 months of dual antiplatelet therapy (aspirin and a P2Y12 receptor antagonist). Clopidogrel and tioclopidine are the most commonly used [133]. 

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