Ischemic events

A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996 348(9038) 1329-1339. 

Schaer BA, Zellweger MJ, Cron TA, Kaiser CA, Osswald S. Value of routine holler monitoring for the detection of paroxysmal atrial HhriUation in patients with cerebral ischemic events. Stroke 2004 35 e68-e70. 

There are two main classifications of cerebral ischemic events transient ischemic attacks and cerebral infarction. 

SUI. Systemic estrogen therapy also carries numerous short- and long-term side effect risks (mastodynia, uterine bleeding, nausea, thromboembolism, cardiac and cerebrovascular ischemic events, and enhanced breast and endometrial cancer risks). If estrogens are to be used in SUI management, only locally-administered products should be used (Table 50-4). 

While the role of PHD inhibitors in the treatment of anemia is now validated, therapeutic validation is less certain in other HIF-associated pathologies such as wound healing, ulcerative colitis, therapeutic angiogenesis, and treatment of acute ischemic events such as myocardial ischemia and stroke. All of these indications are supported by a compelling array of in vitro and in vivo preclinical studies but their utility in the clinical setting remains to be evaluated and represents exciting possibilities for the future of small-molecule inhibitors of PHD enzymes. 

Thus, it is possible that recurrent mood disorders, as in the case of bipolar disorder, may lower the threshold for cell death and/or atrophy in response to a variety of other physiological (e.g. normal aging) and pathological (e.g. ischemic) events, and thereby contribute to a variety of deleterious health-related effects. 

For variant angina, reduction in symptoms and nitroglycerin consumption as documented by a patient diary can assist the interpretation of objective data obtained from ambulatory ECG recordings. Evidence of efficacy includes the reduction of ischemic events, both ST-segment depression and elevation. Additional evidence is a reduced number of attacks of angina requiring hospitalization, and the absence of MI and sudden death. 

Rosiglitazone has been associated with an increased risk of myocardial ischemic events such as angina or myocardial infarction in several studies. Although causality has not been conclusively established, the FDA has required that a black box warning be added to the labeling. A new longterm study to evaluate potential cardiovascular risks is planned. 

A very innovative area of research has focused on the determinants of plaque stability. An important role seems to be played by enzymes involved in the degradation of the extracellular matrix. The rupture of unstable plaques induces platelet activation, too. Acute thrombus formation under these conditions seems fundamental to the onset of acute ischemic events. 

At this time, however, we are not aware of any compounds selected primarily by their neuroprotection activity on rodent models that have established clinical efficacy for dementias or related neurodegenerative diseases. This may be partially explained by their priority development for stroke, and clinicians have found it is difficult or unlikely to slow the ischemia in patients if they are not treated aggressively within 3 h of the initial ischemic event. The speed of neurodegeneration in stroke (cerebral ischemia) makes it a much more difficult target for drug intervention than neurodegeneration from slower pathologies such as Alzheimer s, Parkinson s, and malfunctions in neurotransmitters. 

Molecular imaging may potentially address not only the pathophysiology of ischemia but also vascular inflammation causing rupture of atherosclerotic plaques before major ischemic events. Initial approaches have used imaging of "indium radiolabeled monocytes [150], upregulated metallo-proteinases [151], and imaging of apoptosis in atherosclerotic lesions [152]. However, none have evolved into clinically useful tests. 

Among all ischemic events, perinatal HI—and the resulting neonatal encephalopathy— has perhaps been the most extensively studied by... 

Topol EJ, Moliterno DJ, Hermann HC, Powers ER, et al. 2001. Comparison of two platelet glycoproteins Ilb/IIIa inhibitors, Tirofiban and abciximab, for the prevention of ischemic events with precutaneous coronary revascularization. NEJM. 344 1888-1894. 

Abbott Abbokinase (urokinase Ischemic events Expired Expired... 

Antman EM, McCabe CH, Gurfinkel ER et al. Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) I I B trial. Circulation 1999 100 1593-1601. 

Interestingly, FpA also increased despite maximal anticoagulation with heparin. The correlation between increased FpA plasma levels and increased incidence of complications and ischemic events indicated the involvement of heparin-resistant thrombin activity into the failure of the intervention... 

---