Outcomes with increased length of dual antiplatelet therapy after PCI  

The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is uncertain. Although observational studies have suggested DAPT for longer than a year post-PCI reduces ischemic events, other studies suggest longer durations of DAPT confer no benefits despite increased bleeding risk. This randomized controlled trial evaluated patient outcomes with 12-months vs 30-months […]

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Smoking and antiplatelet agents – smoke and mirrors or something more?

Many antiplatelet therapies are prodrugs that require metabolic activation.  It has been hypothesized that smoking may activate this metabolic conversion for some antiplatelets (i.e. clopidogrel) more than others (i.e. prasugrel and ticagrelor).  In this systematic review and meta-analysis, the authors identified 9 randomized controlled trials of clopidogrel, prasugrel, or ticagrelor which examined outcomes among subgroups […]

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Triple therapy post-PCI? WOEST clarifies

20-30% of patients taking oral anticoagulants also have ischaemic heart disease that requires treatment by percutaneous coronary intervention (PCI), thereby necessitating dual anti-platelet therapy to prevent stent thrombosis. However, the combination of dual anti-platelet therapy (DAP) and anti-coagulants is associated with a high annual risk of fatal and non-fatal bleeding episodes. This study hypothesised that […]

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RAPID GENE shows utility of bedside genetic testing

The CYP2C19*2 allele is a common genetic variant that has been associated with a significantly increased risk of major cardiovascular events and stent thrombosis following percutaneous coronary intervention (PCI).  In this study a novel point-of-care genetic test was used to identify carriers of the CYP2C19*2 allele and to tailor a pharmacogenetic appriach to dual antiplatelet […]

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Bedside genetic test identifies non-responders to Clopidogrel

Clopidogrel is an inactive prodrug that requires hepatic bioactivation via several cytochrome P450 enzymes, including CYP2C19. A number of different alleles of CYP2C19 have been identified; depending on the allele present the enzymatic activity of CYP2C19 can be normal, or reduced. […]

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Genetic factors related to early stent thrombosis

Dual anti-platelet therapy (DAPT) reduces cardiovascular events after PCI by more than 80%.  However, stent thrombosis can occur in 0.5% to 4% of patients within the first year following PCI, with the majority occurring in the first month.  Cayla et al. performed a case-control study using a candidate gene approach – looking in particular at […]

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High Residual Platelet Reactivity Predicts Future Cardiovascular Events

With the increased use of platelet function testing, high residual platelet reactivity (HRPR) has been found to associate with a high risk of ischaemic events following percutaenous coronary intervention (PCI).  However, few data exist for patients with acute coronary syndromes (ACS).  To this end, the Responsiveness to Clopidogrel and Stent Thrombosis 2-ACS (RECLOSE 2-ACS) study […]

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No benefit from platelet testing post PCI

Clopidogrel is a prodrug that needs to be converted into an active metabolite in order to be active, however wide interindividual variability has been noted both in the concentration of active metabolite and also platelet responsiveness.  The GRAVITAS (Gauging Responsiveness with A VerifyNow assay – Impact on Thrombosis and Safety) aimed to investigate the effect […]

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Clopidogrel and Asprin ACTIVEly prevent stroke

The ACTIVE Trial (Atrial Fibrillation Clopidogrel Trial with Irbesartan for the Prevention of Vascular Events) was designed to assess the role of clopidogrel and aspirin in the prevention of stroke and other vascular events in patients with atrial fibrillation (AF). ACTIVE W has already reported and compared clopidogrel + aspirin with a vitamin K antagonist. […]

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Prasugrel proves powerful in STEMI

Prasugrel is novel third-generation thienopyridine which is a more potent blocker of the platelet P2Y12 receptor than clopidogrel.The TRITON-TIMI 38 (Trial to assess Improvement in Therapeutic Outcomes by optimizing platelet inhibition with prasugrel – Thrombolysis in Myocardial Infarction 38) study compared clopidogrel with prasugrel in the setting of ST elevation myocardial infarction (STEMI). […]

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