Combination antithrombotic therapies.

Sinai Center for Thrombosis Research, Cardiac Catheterization Laboratories, Sinai Hospital of Baltimore, 2401 W Belvedere Ave, Baltimore, MD 21215, USA.
Circulation (Impact Factor: 14.95). 02/2010; 121(4):569-83. DOI: 10.1161/CIRCULATIONAHA.109.853085
Source: PubMed
  • [Show abstract] [Hide abstract]
    ABSTRACT: There has been a 3-fold increase in hospital discharges for heart failure (HF) and also significantly increased mortality rate in HF patients in recent years. A major focus of HF research has been in the area of neurohormonal control and resynchronization therapy. There is a great urgency in better understanding the pathophysiology underlying the exceedingly high mortality and a need for exploration of therapeutic strategies beyond those that influence neurohormonal pathways. The decision to treat patients with HF with antiplatelet therapy remains largely influenced by the presence or absence of concomitant arterial disease. Antithrombotic therapy has been shown to be effective in many forms of cardiac disease, including patients with HF and atrial fibrillation. Although it is clear that platelet activation and hypercoagulability are present in HF, and there is evidence that stroke is reduced by warfarin therapy in the HF patient, the available data suggest that the risk of major bleeding overshadows the antithromboembolic benefit in HF patients in sinus rhythm. The utility of oral anticoagulant and/or antiplatelet therapy has never been evaluated in an adequately powered dedicated clinical trial of HF patients in sinus rhythm. In this state-of-the art paper we explore the evidence for targeting the inhibition of platelet function and coagulation to improve outcomes in the HF patient.
    JACC. Heart failure. 02/2014; 2(1):1-14.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Actualmente está bien establecido que la alta reactividad plaquetaria a la adenosina difosfato durante el tratamiento con clopidogrel es un factor independiente predictivo del riesgo de eventos isquémicos en pacientes a los que se ha practicado una intervención coronaria percutánea. Sin embargo, el papel exacto de las pruebas de la función plaquetaria sigue siendo objeto de controversia. Las pruebas de la función plaquetaria para asegurar una inhibición plaquetaria óptima han sido recomendadas por algunos autores para mejorar los resultados en los pacientes tratados con clopidogrel. En ensayos prospectivos y aleatorizados recientes sobre tratamiento antiagregante plaquetario personalizado, no se ha podido demostrar un efecto favorable de las pruebas de la función plaquetaria en cuanto a mejora de los resultados clínicos. En este artículo se analizan los mecanismos de la falta de respuesta a clopidogrel, los ensayos recientes de las pruebas de la función plaquetaria y otros nuevos avances en el campo del tratamiento antiagregante plaquetario personalizado. .
    Revista Espanola de Cardiologia 06/2014; · 3.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: It is well established that high on-treatment platelet reactivity to adenosine diphosphate during clopidogrel therapy is an independent risk factor for ischemic event occurrences in a postpercutaneous coronary intervention patients. However, the precise role of platelet function testing remains debated. Platelet function testing to ensure optimal platelet inhibition has been recommended by some authorities to improve outcomes in patients treated with clopidogrel. Recent prospective, randomized trials of personalized antiplatelet therapy have failed to demonstrate a benefit of platelet function testing in improving outcomes. In this review article, we discuss the mechanisms responsible for clopidogrel nonreponsiveness, recent trials of platelet function testing, and other new developments in the field of personalized antiplatelet therapy. Full English text available
    Revista Espa de Cardiologia 05/2014; · 3.20 Impact Factor