Download or read book Clopidogrel and the Newer P2Y12 Antiplatelet Agents written by Michael P. Savage and published by . This book was released on 2019-02-22 with total page 308 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cardiovascular disease remains the leading cause of death in the developed world. By preventing thromboembolic events such as heart attacks and strokes, antiplatelet drugs have become a cornerstone in the treatment of cardiovascular disease. Clopidogrel is a member of the thienopyridine family which inhibit ADP-induced platelet activation by irreversibly binding to the P2Y12 receptor. Clopidogrel is one of the most commonly used medications with over 9 million prescriptions written annually. It is utilized in the treatment of a wide variety of cardiovascular disorders including acute coronary syndromes (ACS), percutaneous coronary intervention (PCI) with stents, cerebrovascular disease, peripheral vascular disease, and structural heart interventions. Most often, clopidogrel is used in combination with low dose aspirin, providing dual antiplatelet therapy (DAPT). Newer, more potent P2Y12 inhibitors, prasugrel and ticagrelor, are now available as alternatives to clopidogrel. These newer agents have been shown to be more effective than clopidogrel in reducing ischemic events in patients with ACS. Recently a novel intravenous P2Y12 inhibitor, cangrelor, has become available for use during PCI in patients who have not been pretreated with an oral P2Y12 inhibitor. This book examines virtually all aspects of P2Y12 inhibitors pharmacology, clinical uses, randomized trial results, guideline recommendations, and adverse drug effects. Important fundamental issues are reviewed including comparative pharmacology of P2Y12 inhibitors, randomized trials of clopidogrel in patients with coronary artery disease, DAPT duration after PCI, and role of platelet function testing. The newer P2Y12 inhibitors (prasugrel, ticagrelor, and cangrelor) receive special focus. Use of antiplatelet therapy in specific patient populations is discussed including patients with coronary bypass graft surgery, peripheral vascular disease, cerebrovascular disease, and structural heart disease. Management of antiplatelet therapy in patients who require anticoagulation is a particularly challenging clinical setting and is the topic of a featured review. Finally, adverse drug effects and reactions are examined in a section highlighting clopidogrel resistance, clopidogrel hypersensitivity, and bleeding complications. This book is designed to provide a comprehensive review of clopidogrel and the newer P2Y12 inhibitors. Towards that end, the authors have enlisted an internationally renowned group of experts as contributors. It is intended to be a resource for clinicians, scientists, pharmacologists, and all healthcare professionals involved in the management of cardiovascular disease.

Download or read book The Comparative Effectiveness Safety Value and Adherence of Newer P2Y12 Inhibitors Versus Clopidogrel in the Context of Heterogeneity written by Kangho Suh and published by . This book was released on 2019 with total page 88 pages. Available in PDF, EPUB and Kindle. Book excerpt: Background P2Y12 inhibitors are a class of medications indicated with aspirin as part of dual antiplatelet therapy (DAPT) for patients with acute coronary syndrome after undergoing percutaneous coronary intervention (PCI). Taking a P2Y12 inhibitor along with aspirin after PCI reduces the incidence of cardiovascular death, nonfatal MI, and stroke in the following year. Clopidogrel, the first oral P2Y12 inhibitor, was approved in 1997 and was used widely as part of DAPT therapy. However, there are some issues with clopidogrel such as low bioavailability and slow onset of platelet inhibition compared to newer agents, heterogeneity in patient response, and drug resistance. These concerns were addressed with two newer oral agents, prasugrel and ticagrelor, which were approved in 2009 and 2011, respectively. This study aims to examine the heterogeneity in treatment effects of these antiplatelet agents and assess how healthcare providers and patients change their behaviors as a result. In Aim 1, I examined whether physicians identify heterogeneity of treatment effects (HTE) with P2Y12 inhibitors and change their prescribing patterns as a result. This is extended into Aim 2, which explored whether physicians' adaptions in prescribing patterns was a cost effective strategy. Aim 3 assessed patients' adherence to P2Y12 inhibitors and determined if any factors were associated with heterogenous impacts along the adherence distribution. Methods In Aim 1, an instrumental variable approach with person-centered treatment effects was used to assess patient-level comparative effectiveness and safety outcomes from January 2010 to December 2017. These outcomes were used to study whether physician adapted their prescribing patterns over the study period to match the most optimal P2Y12 inhibitor with the patient. In Aim 2, results from Aim 1 were extended to develop a hybrid lifetime Markov model to assess whether physicians' adaptive prescribing with P2Y12 inhibitors was a cost effective strategy compared to universal treatment with clopidogrel or the newer P2Y12 inhibitors. Inputs for the 1-year short term model were informed from Aim 1 results, while inputs for the lifetime model were informed from the literature. In Aim 3, conditional and unconditional quantile regression models were used along with more traditional logistic regression models to examine medication adherence of the three P2Y12 inhibitor, and to determine which covariates had heterogenous impacts along the adherence distribution. Patients who received drug eluting stents were measured for 185 days. Results In Aim 1, 52,823 patients were included for analysis. Patients on ticagrelor and prasugrel had a significantly lower probability of major adverse cardiovascular events [-3.97 percentage points (95% CI, -6.97 to -0.26)] and significantly lower probability of major bleeding events [-2.93 percentage points (95% CI, -4.83 to -0.70)] compared to patients on clopidogrel. Physicians were able to better align patients who would benefit on clopidogrel from 17.39% in 2010 to 26.40% by 2015, but patient outcomes were not significantly different than when everyone received ticagrelor or prasugrel. In Aim 2, physicians' adaptive prescribing resulted in 11.63 life-years (LYs), 9.92 quality-adjusted life-years (QALYs), and $72,403 total costs; universal clopidogrel resulted in 11.59 LYs, 9.84 QALYs, and $72,670 total costs; and universal prasugrel or ticagrelor resulted in 11.67 LYs, 10.00 QALYs, and $73,325 total costs. Universal treatment with prasugrel or ticagrelor was a dominant strategy compared to universal treatment with clopidogrel and a cost-effective strategy compared to targeted prescribing with an incremental cost-effectiveness ratio of $11,144/QALY. In Aim 3, adherence to P2Y12 inhibitors were generally high (88.74%, 90.52%, 88.95%, and 89.60% for branded clopidogrel, generic clopidogrel, prasugrel, and ticagrelor, respectively). The unconditional quantile regression approach showed prasugrel and ticagrelor had significantly lower adherence compared to branded clopidogrel, especially around the 30th percentile. Other factors that impacted adherence the most were having comorbid depression and living in the southern region. Conclusions The research from this dissertation provided a deeper understanding of P2Y12 inhibitors and how heterogeneity of treatment effects impacted physician prescribing and in turn the cost-effectiveness of targeted prescribing with these antiplatelet agents. This research also revealed which factors impacted adherence the most along the entire adherence distribution so that future strategies to improve adherence could be better informed.

Download or read book Primary Angioplasty written by Timothy J Watson and published by Springer. This book was released on 2018-07-13 with total page 339 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book is open access under a CC BY 4.0 license. This quick-reference handbook offers a concise and practical review of key aspects of the treatment of ST-segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (PPCI). In the context of STEMI, PPCI is the preferred mode of emergency revascularization. Access to PPCI is rapidly increasing and is now routinely practiced in both general and specialist hospitals and there has been a recent emphasis on developing STEMI networks to enhance and expedite the referral pathway. This coupled with concurrent developments to enhance the safety and efficacy of the PPCI procedure has heralded an era where STEMI interventions are increasingly considered an important subspecialty within interventional cardiology. Written by leading cardiologists who have been instrumental in the adoption of PPCI in their respective institutions, the book provides junior and senior cardiologists alike with insightful and thought-provoking tips and tricks to enhance the success of PPCI procedures, which may in turn translate into direct improvements in outcomes. The book is also relevant for healthcare providers and emergency department physicians.

Download or read book Coming Safely to a Stop a Review of Platelet Activity After Cessation of Antiplatelet Drugs written by and published by . This book was released on 2015 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The platelet P2Y12 antagonists are widely used, usually in combination with aspirin, to prevent atherothrombotic events in patients with acute coronary syndromes during percutaneous coronary intervention and after placement of arterial stents. Inhibition by clopidogrel or prasugrel lasts for the lifetime of the affected platelets and platelet haemostatic function gradually recovers after stopping the drug, as new unaffected platelets are formed. The optimal durations for dual antiplatelet therapy are prescribed by clinical guidelines. Continuation beyond the recommended duration is associated with an increased mortality, mainly associated with major bleeding. Fear of a 'rebound' of prothrombotic platelet activity on stopping the drug has provoked much discussion and many studies. However, review of the available literature reveals no evidence for production of hyper-reactive platelets after cessation of clopidogrel in patients who are stable. Any increase in acute coronary and other vascular events after stopping seems most likely therefore to be due to premature discontinuation or disruption of treatment while thrombotic risk is still high. No difference in rebound was found with the newer P2Y12 inhibitors, although ticagrelor and prasugrel are more potent platelet inhibitors than clopidogrel. Recent randomized controlled trials confirm it is safe to stop the thienopyridine and continue with aspirin alone in most patients after the duration of treatment recommended by the guidelines. Decisions on when to stop therapy in individuals, however, remain challenging and there is a growing rationale for platelet testing to assist clinical judgement in certain situations such as patients stopping dual antiplatelet therapy before surgery or in individuals at highest bleeding or thrombotic risk.

Download or read book Novel P2Y12 Receptor Antagonists Prasugrel and Ticagrelor Systematic Review Indirect Comparison to Clopidogrel in Cardiovascular Disease Design of a Randomized Controlled Trial written by Sabine Steiner-Boeker and published by . This book was released on 2011 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Antiplatelet therapy with clopidogrel is widely used in patients with coronary artery disease, but the recent development of the new P2Y12 receptor antagonists prasugrel and ticagrelor will increase treatment options. An overview of systematic reviews was performed to summarize available evidence on clopidogrel. Current data on prasugrel and ticagrelor were identified by a systematic review and used for an indirect treatment comparison (ITC) of the drugs against each other and versus placebo in the absence of head-to-head clinical trials. Adjusted indirect comparison according to Bucher, Bayesian methods for mixed treatment comparisons using Winbugs, and generalized linear mixed models using SAS were employed for ITC, yielding almost identical results: prasugrel was favored regarding stent thrombosis and ticagrelor regarding major bleeding. However, substantial differences in trial design were identified, demanding caution when interpreting these results. On the basis of the obtained results, a randomized controlled trial was designed within the gap of current evidence.

Download or read book Cardiology Secrets written by Glenn N. Levine and published by Elsevier Health Sciences. This book was released on 2014 with total page 497 pages. Available in PDF, EPUB and Kindle. Book excerpt: Get quick answers to the most important clinical questions with Cardiology Secrets! Using the popular and trusted Secret Series(R) Q&A format, this easy-to-read cardiology book provides rapid access to the practical, "in-the-trenches" know-how you need to succeed both in practice, and on cardiology board and recertification exams. Get the evidence-based guidance you need to provide optimal care for your patients with cardiac heart diseases. Explore effective solutions to a full range of clinical issues including the general examination, diagnostic procedures, arrhythmias, symptoms and disease states, valvular heart disease, cardiovascular pharmacology, and other medical conditions with associated cardiac involvement. Zero in on key information with bulleted lists, mnemonics, practical tips from the leading cardiologists, and "Key Points" boxes that provide a concise overview of important board-relevant content. Review essential material efficiently with the "Top 100 Secrets in Cardiology" - perfect for last-minute study or self-assessment. Apply all the latest advances in clinical cardiology techniques, technology, and pharmacology. Access the complete text and illustrations online at Expert Consult, fully searchable.

Download or read book Practical Manual of Interventional Cardiology written by Annapoorna Kini and published by Springer. This book was released on 2014-11-26 with total page 297 pages. Available in PDF, EPUB and Kindle. Book excerpt: This practical handbook is based on an internal working manual developed by staff and fellows at Mount Sinai Heart Cardiovascular Catheterization Laboratory, renowned for its high-volume and low complication complex coronary procedures. The Practical Handbook of Interventional Cardiology captures the knowledge and methodological know-how from leaders in interventional cardiology, it intends to guide users in a stepwise, methodical and practical approach through various cardiac interventional procedures in order to achieve maximum patient safety and improved outcomes. From patient selection, preoperative work-up, setting up equipment to step-by-step illustrations of various procedural details and troubleshooting, this handbook captures all the details necessary to perform the simplest to the most complex cardiac interventions. The book is designed for cardiologists and trainees who desire an efficient way to review the steps of various cardiac interventional procedures and a quick, reliable reference for everyday use.

Download or read book Antiplatelet and Anticoagulation Therapy In PCI An Issue of Interventional Cardiology Clinics E Book written by Dominick J. Angiolillo and published by Elsevier Health Sciences. This book was released on 2016-11-26 with total page 185 pages. Available in PDF, EPUB and Kindle. Book excerpt: This issue of Interventional Cardiology Clinics, edited by Drs. Dominick Angiolillo and Matthew Price, will focus on Antiplatelet and Anticoagulation Therapy in PCI. The topics covered in this volume will span across pretreatment with antiplatelet agents; optimal duration of antiplatelet therapy after PCI; Cangrelor and its role in percutaneous coronary intervention; Ticagrelor and its effects beyond the P2Y12 receptor; dyspnea and Reversibly-binding P2Y12 antagonists; PAR receptor inhibition post-PCI; switching P2Y12 receptor inhibiting therapies; antiplatelet and antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting; antithrombotic therapy to reduce ischemic events in ACS patients undergoing PCI; and the current role of platelet function testing in PCI and CABG, among other topics.

Download or read book Antiplatelet Agents Advances in Research and Application 2012 Edition written by and published by ScholarlyEditions. This book was released on 2012-12-26 with total page 67 pages. Available in PDF, EPUB and Kindle. Book excerpt: Antiplatelet Agents—Advances in Research and Application: 2012 Edition is a ScholarlyBrief™ that delivers timely, authoritative, comprehensive, and specialized information about Antiplatelet Agents in a concise format. The editors have built Antiplatelet Agents—Advances in Research and Application: 2012 Edition on the vast information databases of ScholarlyNews.™ You can expect the information about Antiplatelet Agents in this eBook to be deeper than what you can access anywhere else, as well as consistently reliable, authoritative, informed, and relevant. The content of Antiplatelet Agents—Advances in Research and Application: 2012 Edition has been produced by the world’s leading scientists, engineers, analysts, research institutions, and companies. All of the content is from peer-reviewed sources, and all of it is written, assembled, and edited by the editors at ScholarlyEditions™ and available exclusively from us. You now have a source you can cite with authority, confidence, and credibility. More information is available at http://www.ScholarlyEditions.com/.

Download or read book Interventional Cardiology written by George D. Dangas and published by John Wiley & Sons. This book was released on 2016-11-28 with total page 2479 pages. Available in PDF, EPUB and Kindle. Book excerpt: Expert guidance from internationally recognized authorities, who provide clear and current updates on all aspects of interventional cardiology. This new edition; Contains a radically expanded chapter contents list presented in four clear sections; coronary interventions, interventional pharmacology, structural heart interventions, and endovascular therapy Includes 46 new chapters, including the latest advances in bioresorbable coronary stents, advanced transcatheter aortic valve replacement, MitraClip, new transcatheter mitral valve interventions, and more Chapters are templated for rapid referral, beginning with pathophysiological background and relevant pathology, moving to mechanisms of treatment, device description, procedural techniques, follow-up care, and ending with risks, contraindications and complications Multiple choice questions at the end of each chapter for self-assessment, a total of more than 400 MCQs in the book Features 19 procedural videos, hosted on a companion website

Download or read book Pharmacology of Purine and Pyrimidine Receptors written by and published by Academic Press. This book was released on 2011-07-13 with total page 558 pages. Available in PDF, EPUB and Kindle. Book excerpt: This is an overview of the fast-moving field of purinergic signalling through adenosine and ATP receptors. - Authors are the leading authorities in their fields - Subject matter is important for understanding tissue protection - Subject matter is of intense interest for new drug development

Download or read book Economic Dimensions of Personalized and Precision Medicine written by Ernst R. Berndt and published by University of Chicago Press. This book was released on 2019-04-22 with total page 361 pages. Available in PDF, EPUB and Kindle. Book excerpt: Personalized and precision medicine (PPM)—the targeting of therapies according to an individual’s genetic, environmental, or lifestyle characteristics—is becoming an increasingly important approach in health care treatment and prevention. The advancement of PPM is a challenge in traditional clinical, reimbursement, and regulatory landscapes because it is costly to develop and introduces a wide range of scientific, clinical, ethical, and socioeconomic issues. PPM raises a multitude of economic issues, including how information on accurate diagnosis and treatment success will be disseminated and who will bear the cost; changes to physician training to incorporate genetics, probability and statistics, and economic considerations; questions about whether the benefits of PPM will be confined to developed countries or will diffuse to emerging economies with less developed health care systems; the effects of patient heterogeneity on cost-effectiveness analysis; and opportunities for PPM’s growth beyond treatment of acute illness, such as prevention and reversal of chronic conditions. This volume explores the intersection of the scientific, clinical, and economic factors affecting the development of PPM, including its effects on the drug pipeline, on reimbursement of PPM diagnostics and treatments, and on funding of the requisite underlying research; and it examines recent empirical applications of PPM.

Download or read book Consultative Hemostasis and Thrombosis E Book written by Craig S. Kitchens and published by Elsevier Health Sciences. This book was released on 2013-02-20 with total page 843 pages. Available in PDF, EPUB and Kindle. Book excerpt: A unique clinical focus makes Consultative Hemostasis and Thrombosis, 3rd Edition your go-to guide for quick, practical answers on managing the full range of bleeding and clotting disorders. Emphasizing real-world problems and solutions, Dr. Craig S. Kitchens, Dr. Barbara A. Konkle, and Dr. Craig M. Kessler provide all the clinical guidance you need to make optimal decisions on behalf of your patients and promote the best possible outcomes. Consult this title on your favorite e-reader with intuitive search tools and adjustable font sizes. Elsevier eBooks provide instant portable access to your entire library, no matter what device you're using or where you're located. Efficiently look up concise descriptions of each condition, its associated symptoms, laboratory findings, diagnosis, differential diagnosis, and treatment. Get the latest information on hot topics such as Disseminated Intravascular Coagulation, Thrombophilia, Clinical and Laboratory Assessment and Management, Thrombotic -Thrombocytopenic Purpura, and Heparin-Induced Thrombocytopenia. Apply today’s newest therapies, including those that are quickly becoming standard in this fast-changing field. Meet the needs of specific patient groups with a new chapter on Bleeding and the Management of Hemorrhagic Disorders in Pregnancy and an extensively updated chapter on Thrombosis and Cancer. Zero in on key information with a new user-friendly design, and all-new full-color format, abundant laboratory protocols, and at-a-glance tables and charts throughout.

Download or read book Antithrombotic Therapy written by Richard C. Becker and published by Professional Communications. This book was released on 2010-12-31 with total page 466 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinical application of antithrombotic therapy in both arterial disease (acute coronary syndromes, acute MI, peripheral arterial disease, valvular heart disease, atrial fibrillation) and venous disease, (venous thromboembolic disease and pulmonary embolism). Results of major clinical trials and their implications for clinical practice.

Download or read book Platelets in Thrombotic and Non Thrombotic Disorders written by Paolo Gresele and published by Springer. This book was released on 2017-03-08 with total page 1402 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book reviews current science and applications in fields including thrombosis and hemostasis, signal transduction, and non-thrombotic conditions such as inflammation, allergy and tumor metastasis. It is a detailed, up-to-date, highly referenced text for clinical scientists and physicians, including recent developments in this rapidly expanding field. More than a scientific resource, this is also an authoritative reference and guide to the diagnosis.

Download or read book Side Effects of Drugs Annual written by Jeffrey K. Aronson and published by Elsevier. This book was released on 2011-08-19 with total page 715 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Side Effects of Drugs Annual was first published in 1977. It has been continually published since then, as a yearly update to the voluminous encyclopedia Meyler's Side Effects of Drugs. Each new Annual continues to provide clinicians and medical investigators with a reliable and critical yearly survey of new data and trends in the area of Adverse Drug Reactions and Interactions. An international team of specialists has contributed to the Annuals by selecting critically from each year's writing all that is truly new and informative, by critically interpreting it, and by pointing to whatever is misleading. - Provides a critical yearly survey of new data and trends - Includes an essay that describes the modern approach to classifying adverse drug reactions - Special reviews in this Annual include, among other topics: Antipsychotic drugs and now-onset diabetes mellitus, Treating asthma during pregnancy, and MMR vaccine and autism

Download or read book Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention written by and published by . This book was released on 2018 with total page 20 pages. Available in PDF, EPUB and Kindle. Book excerpt: Current guidelines recommend that patients be given dual antiplatelet therapy (DAPT; combination of a P2Y12 inhibitor [clopidogrel, prasugrel, or ticagrelor] with acetylsalicylic acid [ASA]) ranging from six months to 12 months following percutaneous coronary intervention (PCI) with stenting, with the aim of preventing stent thrombosis and major adverse cardiac and cerebrovascular events (MACCEs). However, debate is ongoing about the optimal duration of DAPT; importantly, patient characteristics may be an important factor in treatment duration decisions. In some settings, DAPT for even less than six months may be appropriate (e.g., patients with high risk of bleeding), while other patients may derive greater benefit from extended DAPT (e.g., patients with high risk of stent thrombosis and low risk of bleeding). Previous reviews have reported an increased risk of death among patients who received DAPT for more than 12 months following PCI with stenting, but whether this risk is common across all patient subgroups is unclear. Previous systematic reviews (SRs) have attempted to determine the optimal duration of DAPT; however, there is a paucity of data on the impact of specific patient characteristics or type of P2Y12 inhibitor on the effect estimate. One SR reported that extending DAPT beyond 12 months reduced the risk of stent thrombosis in patients without, but not with, acute coronary syndrome (ACS); however, no significant differences were reported in the risk of cardiovascular (CV) death or myocardial infarction (MI). A recent network metaanalysis (NMA) found that among patients randomized to ticagrelor, prasugrel, or clopidogrel, the risk of major adverse cardiac events and MI were lower with both ticagrelor and prasugrel compared with clopidogrel. Shah et al. reported a reduced risk of all-cause and CV death among patients randomized to ticagrelor compared with clopidogrel; however, whether these results are consistent at all durations of DAPT is unknown. To make appropriate decisions, clinicians require a transparent and comprehensive review of the evidence to evaluate the potential benefits and harms associated with extending DAPT beyond 12 months after stenting to potentially personalize therapy and reach best patient outcomes. Such information may also inform P2Y12 inhibitor reimbursement policies by insurers because such policies may be limited to 12 months, in particular in the public sector. In this study, we will evaluate the comparative clinical effectiveness of different DAPT durations by performing an SR to assess the benefits and harms associated with extending DAPT beyond 12 months following PCI with stenting. We will also investigate the effect of extended DAPT in clinically relevant patient subgroups, including age, history of MI, ACS at presentation, diabetes, and smoking status, and the impact of individual P2Y12 inhibitors. Of note, the patient subgroups were selected based on the clinical components of the DAPT Score combined with consideration of findings from a recent clinical review that found different effects between shorter and longer DAPT duration for some subgroups; the selected subgroups were chosen because statistically significant differences were observed in key clinical outcomes when extended DAPT was used. In addition, we will evaluate the comparative cost-effectiveness of different DAPT durations; results from the clinical review will be used to inform clinical input for the economic evaluation.