Download or read book Testing of CYP2C19 Variants and Platelet Reactivity for Guiding Antiplatelet Treatment written by Issa J. Dahabreh and published by . This book was released on 2013 with total page 345 pages. Available in PDF, EPUB and Kindle. Book excerpt: OBJECTIVES: This comparative effectiveness review evaluated the analytic validity, prognostic value, and comparative effectiveness of two types of medical tests (genetic testing for CYP2C19 variants and phenotypic testing to measure platelet reactivity) to identify patients who are most likely to benefit from clopidogrel-based antiplatelet therapy and to guide antiplatelet therapy in patient populations who are eligible to receive or are already receiving clopidogrel treatment. DATA SOURCES: We searched MEDLINE(r), the Cochrane Central Trials Registry, the Cochrane Database of Systematic Reviews, the Human Genome Epidemiology Network database, and the National Institutes of Health Genetic Association Database, from inception to July 27, 2012. We also searched the Food and Drug Administration Web site and ClinicalTrials.gov, and contacted test manufacturers and authors of primary studies. REVIEW METHODS: We used established systematic review methods to identify English-language articles describing studies performed in all relevant care settings on the basis of predetermined eligibility criteria: adult patients with cardiovascular, cerebrovascular, or peripheral arterial disease who were candidates for or were receiving clopidogrel; use of genetic testing (for CYP2C19 variants) or phenotypic testing (for platelet reactivity). Studies had to report information on the analytic validity, prognostic ability for intermediate (platelet reactivity) or clinical outcomes, use of tests to guide antiplatelet therapy, or adverse events from testing itself or from test-directed treatment. RESULTS: The literature search yielded 10,475 unique citations, 1,419 of which were obtained in full text and reviewed. A total of 326 publications were judged to have met the inclusion criteria. (Some publications contributed data to multiple analyses.) Eleven studies provided information for the analytic validity of genotyping assays and 105 for the analytic validity of platelet reactivity assays. Test-retest reliability and interassay agreement for genotyping assays appeared adequate; however, few studies were available. Agreement between assays for measuring platelet reactivity was poor to moderate. Generally, agreement was higher between measurements obtained from the same assay using different agonist concentrations than between different assay types. Only 12 studies provided information on analytic test performance, and they reported variable results. One hundred six studies provided information on the ability of genetic testing for CYP2C19 variants to predict clinical outcomes or platelet reactivity during followup. The majority of studies were conducted in populations with ischemic heart disease. Under a dominant model, loss-of-function alleles were associated with higher on-clopidogrel platelet reactivity and were statistically significantly associated with stent thrombosis (relative risk [RR] = 1.52; 95% confidence interval [CI], 1.17 to 1.97); major adverse cardiovascular events (RR=1.20; 95% CI, 1.04 to 1.39); and cardiovascular mortality (RR=1.98; 95% CI, 1.13 to 3.46). Associations were nonstatistically significant in meta-analyses of loss-of-function alleles and all-cause mortality, acute coronary syndromes, stroke, and bleeding events. Sensitivity analyses under recessive and additive models for the two outcomes with adequate data (major adverse cardiovascular events and stent thrombosis) produced results in the same direction but with larger effect sizes than the dominant model. Under a dominant model, gain-of-function alleles were significantly associated with reduced risk of major adverse cardiovascular events (RR=0.82; 95% CI, 0.74 to 0.92). One hundred twenty-eight studies provided information on the ability of baseline on-clopidogrel platelet reactivity to predict clinical outcomes or platelet reactivity during followup. The majority of studies were conducted in populations with ischemic heart disease. Patients with high platelet reactivity at baseline were more likely to be clopidogrel nonresponders during followup. The ability to predict clinical outcomes was reported for various assays; the most commonly assessed were light-transmission aggregometry (55 studies); VerifyNow P2Y12 (38 studies); vasodilator-stimulated phosphoprotein assay (19 studies); Multiplate analyzer (18 studies); and Platelet Function Analyzer-100 (11 studies). Overall, studies suggested that increased on-clopidogrel reactivity was associated with increased rates of adverse cardiovascular outcomes. Fourteen studies provided information on the use of genetic testing for CYP2C19 variants for guiding treatment choice: 1 randomized trial of testing versus no testing, 12 randomized treatment trials assessing effect modification by CYP2C19 status, 1 randomized treatment trial selecting patients on the basis of CYP2C19 genotype. Twenty-four studies provided information on the use of platelet reactivity measurements to guide antiplatelet therapy: 7 comparative studies of alternative testing strategies (6 with random allocation), 3 randomized treatment trials assessing effect modification by reactivity status, 14 randomized treatment trials selecting patients on the basis of platelet reactivity levels. Studies had heterogeneous designs and compared different treatment strategies. Overall, there was insufficient evidence regarding the use of genotyping CYP2C19 variants or phenotypic testing for platelet reactivity to guide treatment selection. CONCLUSIONS: We found evidence to support an association between loss-of-function CYP2C19 variants and increased risk of adverse cardiovascular outcomes. Similarly, we found evidence that high on-clopidogrel platelet reactivity is associated with an increased risk of adverse cardiovascular outcomes, at least for some of the available assays. The strength of evidence regarding these prognostic effects was judged to be low or moderate because of concerns regarding selective outcome reporting and publication bias, and the relatively small number of studies reporting data on most clinical outcomes. The strength of evidence regarding the use of genetic or platelet reactivity testing to guide antiplatelet treatment selection was judged to be insufficient because studies reporting on clinical outcomes were few, had diverse designs, and included heterogeneous populations. Comparative data on alternative test strategies (genetic versus phenotypic) are lacking.

Download or read book Testing of CYP2C19 Variants and Platelet Reactivity for Guiding Antiplatelet Treatment written by and published by . This book was released on 2013 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Testing of Cyp2c19 Variants and Platelet Reactivity for Guiding Antiplatelet Treatment written by Agency for Healthcare Research and Quality and published by CreateSpace. This book was released on 2015-02-11 with total page 362 pages. Available in PDF, EPUB and Kindle. Book excerpt: Platelets play a role in the development of atherosclerotic vascular diseases such as acute and chronic coronary artery disease, ischemic cerebrovascular disease (i.e., ischemic stroke or transient ischemic attack), and peripheral arterial disease. Specifically, platelet activation and aggregation, and the interaction of platelets with blood cells and the endothelium, contribute to the pathophysiology of these diseases. Furthermore, platelets participate in thrombus formation in the setting of atrial fibrillation. Because of the importance of platelets in disease processes that often culminate in major adverse clinical events (e.g., myocardial infarction, ischemic stroke, or cardiovascular death), there is a strong rationale for the development of therapies specifically targeting platelet function for the primary and secondary prevention of cardiovascular disease. Because patient response to antiplatelet treatments is variable, there is also great interest in developing biomarkers to predict treatment response and guide treatment selection. Approximately 82 million Americans currently suffer from some form of cardiovascular disease. Randomized controlled trials have established dual antiplatelet treatment with clopidogrel and aspirin as the current standard of care for medical and interventional management of acute coronary syndromes. Dual antiplatelet treatment is also recommended for patients undergoing PCI with placement of stents (either bare metal or drug eluting). Randomized controlled trials support the use of clopidogrel in patients who have experienced acute cardiovascular events (e.g., stroke) and those with peripheral arterial disease. For patients with atrial fibrillation and contraindications to vitamin K antagonists, the ACTIVE A (Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events) trial suggested that the combination of clopidogrel and aspirin is more effective than aspirin alone for preventing thromboembolic disease. Since the approval of clopidogrel by the U.S. Food and Drug Administration (FDA) for routine clinical use, the drug has become one of the most commonly prescribed agents in the United States. However, patient response to clopidogrel-based antiplatelet therapy is variable both between patients and across multiple measurements within a patient, with some patients showing no or minimal platelet response to clopidogrel administration (often termed clopidogrel “nonresponsiveness” or “resistance”). Alternatives to standard clopidogrel treatment include higher dose clopidogrel regimens and the use of other antiplatelet agents, such as prasugrel or ticagrelor. Given the availability of alternative antiplatelet strategies and concern about adverse clinical outcomes in clopidogrel nonresponders, research has focused on methods to identify patients who are unlikely to benefit from clopidogrel-based treatment. The question of identifying the optimal antiplatelet therapy may also carry cost implications because generic clopidogrel products are now available in the United States.

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 Antiplatelet Therapy in Cardiovascular Disease written by Ron Waksman and published by John Wiley & Sons. This book was released on 2014-03-24 with total page 363 pages. Available in PDF, EPUB and Kindle. Book excerpt: Edited by a team of the world’s leading interventional cardiologists and educators, this new book is created with an eye to giving the reader a solid, practical, and clinically focused understanding of this important class of drugs, from basic science to a clear-headed discussion of complex topics such as combination therapies, drug-to-drug interactions, and resistance to antiplatelet agents. This important new book: Begins with a concise but thorough discussion of platelet biology and pathophysiology so that readers understand how antiplatelet agents work and why they produce such a varied range of complications, from minor GI upset to potentially life-threatening conditions such as neutropenia, a critical shortage of white blood cells. Thoroughly covers platelet function testing, including novel techniques. Clarifies current best practice regarding the use of antiplatelet agents in both chronic and acute cardiovascular disease. Reviews all types of antiplatelet agents – from aspirin to recently approved drugs – including indications, clinical outcomes, and side effects. Written by an international “who’s who” of experts in the field, Antiplatelet Therapy in Cardiovascular Disease also includes an entire section covering the use of antiplatelet drugs in PCIs, including percutaneous valve repair, which makes this text particularly essential to interventional cardiologists.

Download or read book Textbook of Personalized Medicine written by Kewal K. Jain and published by Humana Press. This book was released on 2015-03-17 with total page 762 pages. Available in PDF, EPUB and Kindle. Book excerpt: Advances in the technology used in personalized medicine and increased applications for clinical use have created a need for this expansion and revision of Kewal K. Jain’s Textbook of Personalized Medicine. As the first definitive work on this topic, this book reviews the fundamentals and development of personalized medicine and subsequent adoptions of the concepts by the biopharmaceutical industry and the medical profession. It also discusses examples of applications in key therapeutic areas, as well as ethical and regulatory issues, providing a concise and comprehensive source of reference for those involved in healthcare management, planning and politics. Algorithms are included as a guide to those involved in the management of important diseases where decision-making is involved due to the multiple choices available. Textbook of Personalized Medicine, Second Edition will serve as a convenient source of information for physicians, scientists, decision makers in the biopharmaceutical and healthcare industries and interested members of the public.

Download or read book Pharmacogenomics in Precision Medicine written by Weimin Cai and published by Springer Nature. This book was released on 2020-06-12 with total page 290 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides an introduction to the principles of pharmacogenomics and precision medicine, followed by the pharmacogenomics aspects of major therapeutic areas such as cardiovascular disease, cancer, organ transplantation, psychiatry, infection, antithrombotic drugs. It also includes genotyping technology and therapeutic drug monitoring in Pharmacogenomics; ethical, Legal and Regulatory Issues; cost-effectiveness of pharmacogenetics-guided treatment; application of pharmacogenomics in drug discovery and development and clinical Implementation of Pharmacogenomics for Personalized Precision Medicine. The contributors of Pharmacogenomics in Precision Medicine come from a team of experts, including professors from academic institutions and practitioner from hospital. It will give an in-depth overview of the current state of pharmacogenomics in drug therapy for all health care professionals and graduate students in the era of precision medicine.

Download or read book Point of care testing written by Peter Luppa and published by Springer. This book was released on 2018-07-18 with total page 445 pages. Available in PDF, EPUB and Kindle. Book excerpt: The underlying technology and the range of test parameters available are evolving rapidly. The primary advantage of POCT is the convenience of performing the test close to the patient and the speed at which test results can be obtained, compared to sending a sample to a laboratory and waiting for results to be returned. Thus, a series of clinical applications are possible that can shorten the time for clinical decision-making about additional testing or therapy, as delays are no longer caused by preparation of clinical samples, transport, and central laboratory analysis. Tests in a POC format can now be found for many medical disciplines including endocrinology/diabetes, cardiology, nephrology, critical care, fertility, hematology/coagulation, infectious disease and microbiology, and general health screening. Point-of-care testing (POCT) enables health care personnel to perform clinical laboratory testing near the patient. The idea of conventional and POCT laboratory services presiding within a hospital seems contradictory; yet, they are, in fact, complementary: together POCT and central laboratory are important for the optimal functioning of diagnostic processes. They complement each other, provided that a dedicated POCT coordination integrates the quality assurance of POCT into the overall quality management system of the central laboratory. The motivation of the third edition of the POCT book from Luppa/Junker, which is now also available in English, is to explore and describe clinically relevant analytical techniques, organizational concepts for application and future perspectives of POCT. From descriptions of the opportunities that POCT can provide to the limitations that clinician’s must be cautioned about, this book provides an overview of the many aspects that challenge those who choose to implement POCT. Technologies, clinical applications, networking issues and quality regulations are described as well as a survey of future technologies that are on the future horizon. The editors have spent considerable efforts to update the book in general and to highlight the latest developments, e.g., novel POCT applications of nucleic acid testing for the rapid identification of infectious agents. Of particular note is also that a cross-country comparison of POCT quality rules is being described by a team of international experts in this field.

Download or read book Platelets written by Alan D. Michelson and published by Elsevier. This book was released on 2011-08-29 with total page 1386 pages. Available in PDF, EPUB and Kindle. Book excerpt: Platelets, Second Edition is the definitive current source of state-of-the-art knowledge about platelets and covers the entire field of platelet biology, pathophysiology, and clinical medicine. Recently there has been a rapid expansion of knowledge in both basic biology and the clinical approach to platelet-related diseases including thrombosis and hemorrhage. Novel platelet function tests, drugs, blood bank storage methods, and gene therapies have been incorporated into patient care or are in development. This book draws all this information into a single, comprehensive and authoritative resource. First edition won Best Book in Medical Science Award from the Association of American Publishers Contains fourteen new chapters on topics such as platelet genomics and proteomics, inhibition of platelet function by the endothelium, clinical tests of platelet function, real time in vivo imaging of platelets, and inherited thrombocytopenias A comprehensive full color reference comprising over 70 chapters, 1400 pages, and 16,000 references

Download or read book The ESC Textbook of Intensive and Acute Cardiovascular Care written by Marco Tubaro and published by Oxford University Press. This book was released on 2021-03-08 with total page 800 pages. Available in PDF, EPUB and Kindle. Book excerpt: The ESC Textbook of Intensive and Acute Cardiovascular Care is the official textbook of the Acute Cardiovascular Care Association (ACVC) of the ESC. Cardiovascular diseases (CVDs) are a major cause of premature death worldwide and a cause of loss of disability-adjusted life years. For most types of CVD early diagnosis and intervention are independent drivers of patient outcome. Clinicians must be properly trained and centres appropriately equipped in order to deal with these critically ill cardiac patients. This new updated edition of the textbook continues to comprehensively approach all the different issues relating to intensive and acute cardiovascular care and addresses all those involved in intensive and acute cardiac care, not only cardiologists but also critical care specialists, emergency physicians and healthcare professionals. The chapters cover the various acute cardiovascular diseases that need high quality intensive treatment as well as organisational issues, cooperation among professionals, and interaction with other specialities in medicine. SECTION 1 focusses on the definition, structure, organisation and function of ICCU's, ethical issues and quality of care. SECTION 2 addresses the pre-hospital and immediate in-hospital (ED) emergency cardiac care. SECTIONS 3-5 discuss patient monitoring, diagnosis and specific procedures. Acute coronary syndromes (ACS), acute decompensated heart failure (ADHF), and serious arrhythmias form SECTIONS 6-8. The main other cardiovascular acute conditions are grouped in SECTION 9. Finally SECTION 10 is dedicated to the many concomitant acute non-cardiovascular conditions that contribute to the patients' case mix in ICCU. This edition includes new chapters such as low cardiac output states and cardiogenic shock, and pacemaker and ICDs: troubleshooting and chapters have been extensively revised. Purchasers of the print edition will also receive an access code to access the online version of the textbook which includes additional figures, tables, and videos to better to better illustrate diagnostic and therapeutic techniques and procedures in IACC. The third edition of the ESC Textbook of Intensive and Acute Cardiovascular Care will establish a common basis of knowledge and a uniform and improved quality of care across the field.

Download or read book Textbook of Interventional Neurology written by Adnan I. Qureshi and published by Cambridge University Press. This book was released on 2011-04-14 with total page 515 pages. Available in PDF, EPUB and Kindle. Book excerpt: Endovascular intervention - using medication and devices introduced through catheters or microcatheters placed into the blood vessels through a percutaneous approach - has emerged as a relatively new minimally invasive approach to treat cerebrovascular disease and possibly intracranial neoplasms. This textbook provides a comprehensive review of principles pertinent to endovascular treatment of cerebrovascular diseases and intracranial tumors, with a detailed description of techniques for these procedures and periprocedural management strategies. Particular emphasis is placed on expert interpretation of the quality of evidence provided and implications for practice related to endovascular procedures. This will be essential reading for clinicians working in interventional neurology and cardiology, endovascular neurosurgery, vascular surgery and neuroradiology.

Download or read book Handbook of Drug Nutrient Interactions written by Joseph I. Boullata and published by Springer Science & Business Media. This book was released on 2010-03-17 with total page 823 pages. Available in PDF, EPUB and Kindle. Book excerpt: Handbook of Drug-Nutrient Interactions, Second Edition is an essential new work that provides a scientific look behind many drug-nutrient interactions, examines their relevance, offers recommendations, and suggests research questions to be explored. In the five years since publication of the first edition of the Handbook of Drug-Nutrient Interactions new perspectives have emerged and new data have been generated on the subject matter. Providing both the scientific basis and clinical relevance with appropriate recommendations for many interactions, the topic of drug-nutrient interactions is significant for clinicians and researchers alike. For clinicians in particular, the book offers a guide for understanding, identifying or predicting, and ultimately preventing or managing drug-nutrient interactions to optimize patient care. Divided into six sections all chapters have been revised or are new to this edition. Chapters balance the most technical information with practical discussions and include outlines that reflect the content; discussion questions that can guide the reader to the critical areas covered in each chapter, complete definitions of terms with the abbreviation fully defined and consistent use of terms between chapters. The editors have performed an outstanding service to clinical pharmacology and pharmaco-nutrition by bringing together a multi-disciplinary group of authors. Handbook of Drug-Nutrient Interactions, Second Edition is a comprehensive up-to-date text for the total management of patients on drug and/or nutrition therapy but also an insight into the recent developments in drug-nutrition interactions which will act as a reliable reference for clinicians and students for many years to come.

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 Rowland and Tozer s Clinical Pharmacokinetics and Pharmacodynamics Concepts and Applications written by Hartmut Derendorf and published by Lippincott Williams & Wilkins. This book was released on 2019-07-11 with total page 864 pages. Available in PDF, EPUB and Kindle. Book excerpt: Updated with the latest clinical advances, Rowland and Tozer’s Clinical Pharmacokinetics and Pharmacodynamics, Fifth Edition , explains the relationship between drug administration and drug response, taking a conceptual approach that emphasizes clinical application rather than science and mathematics. Bringing a real-life perspective to the topic, the book simplifies concepts and gives readers the knowledge they need to better evaluate drug applications.

Download or read book Antiplatelet Agents written by Paolo Gresele and published by Springer Science & Business Media. This book was released on 2012-08-23 with total page 616 pages. Available in PDF, EPUB and Kindle. Book excerpt: Antiplatelet therapy is the cornerstone of treatment of ischemic cardiovascular disease and over the last few years spectacular advancements in this field have been recorded. This is the first comprehensive handbook entirely dedicated to all the aspects of antiplatelet therapy. The book is divided into three main sections, pathophysiology, pharmacology and therapy, for a total of 23 chapters. A large group of leading experts from different European countries and from the USA, both from academia and industry, have contributed to the book. Besides a detailed overview on the pharmacology and clinical applications of all the currently used or of the novel antiplatelet agents, innovative approaches (e.g. intracellular signalling as an antiplatelet target, small RNAs as platelet therapeutics, etc.) or unconventional aspects (e.g. pharmacologic modulation of the inflammatory action of platelets are also treated. The book is oriented to both basic investigators and to clinicians involved with research on platelet inhibition or with the clinical use of antiplatelet therapies.

Download or read book Prevention and Treatment of Atherosclerosis written by Arnold von Eckardstein and published by Springer Nature. This book was released on 2022 with total page 537 pages. Available in PDF, EPUB and Kindle. Book excerpt: This open access book is supported by the European Atherosclerosis Society Association (EAS). This follow-up edition of the well-received Handbook volume 'Atherosclerosis: Diet and Drugs' reflects the state-of-the-art and most recent developments in atherosclerosis research. Outstanding international experts give a comprehensive overview of the field covering topics, such as improving the treatment focusing on established targets, novel drug developments addressing pre-defined targets, hypothesis-based and hypothesis-free approaches to unravel novel targets.

Download or read book ASPC Manual of Preventive Cardiology written by Ezra A. Amsterdam and published by Demos Medical Publishing. This book was released on 2014-10-23 with total page 295 pages. Available in PDF, EPUB and Kindle. Book excerpt: Endorsed by the American Society for Preventive Cardiology, this highly practical resource focuses on the application of current guidelines and practice standards in the clinical management of cardiovascular risk factors. The Manual presents concise descriptions of each major cardiovascular risk factor, and practical, to-the-point discussions of current best practices in clinical management. In addition, the Manual includes chapters on peripheral arterial disease, stroke, smoking, contemporary cardiovascular imaging, heart failure, metabolic syndrome, thrombosis, nutrition, special populations, novel risk factors, and psychosocial stress. Throughout the Manual, recommendations are based on the most recent prevention guidelines of the American College of Cardiology and American Heart Association, including those on Risk Assessment, Lifestyle Recommendations, Blood Cholesterol, and Obesity, as well as the new guidelines on Hypertension. Chapter authors are recognized leaders in each area of practice, and special efforts have been made by the authors and editors to ensure that the content of all chapters is as up-to-date as possible. Key Features: Presents a highly practical focus on the application of current guidelines and practice standards regarding cardiovascular risk factors Recommendations based on the most recent prevention guidelines Authored by recognized leaders in the field Covers all major cardiovascular risk factors, key methodologies in risk assessment, and special issues regarding specific patient populations