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    • "Antiplatelet therapy is considered a gold standard for its effectiveness in both primary and secondary prevention of atherothrombotic events. Dual antiplatelet therapy (DAPT) with a combination of the COX-1 inhibitor aspirin and the P2Y 12 antagonist clopidogrel has become critical in the successful management of ACS patients and patients undergoing PCI [4] [5]. "

    Thrombosis Research 04/2015; 135(6). DOI:10.1016/j.thromres.2015.04.008 · 2.45 Impact Factor
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    • "Hence, an expansion in the choice of treatment options, together with a requirement for transparency in the process that defines appropriate treatment, has led to calls for a multidisciplinary team (MDT) approach to guide management of patients with CAD. The Heart Team is included in European and American guidelines on myocardial revascularization as a class 1C recommendation [3] [4] [8]. The 2014 European Society of Cardiology (ESC) and the European Association for Cardiothoracic Surgery (EACTS) Guidelines provide further clarification regarding which patient group needs a Heart-Team discussion and when an 'ad hoc' PCI option is justifiable [8]. "
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    ABSTRACT: The decision-making process in the management of patients with ischaemic heart disease has historically been the responsibility of the cardiologist and encompasses medical management, percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Currently, there is significant geographical variability in the PCI:CABG ratio. There are now emerging recommendations that this decision-making process should be carried out through a multidisciplinary approach, namely the Heart Team. This work was carried out on behalf of The British Cardiovascular Society (BCS), Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS) and British Cardiovascular Intervention Society (BCIS). This manuscript sets out the principles for the functioning of the Heart Team. This work has been approved by the Executive Committees of BCS/BCIS/SCTS. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2015; 48(4). DOI:10.1093/ejcts/ezv083 · 3.30 Impact Factor
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    • "Though dual antiplatelet therapy (DAPT) has markedly reduced the occurrence of stent thrombosis related catastrophic event, the optimal duration of DAPT after DES placement is still unknown. The current guidelines on the optimal duration of DAPT in PCI setting are rather discordant based on the results of studies which are often controversial.[2]–[5] Cessation of DAPT during the first 6 months after DES implantation, even if temporary, significantly increases the risk of stent thrombosis. "
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    ABSTRACT: In-stent thrombosis after cessation of antiplatelet medications in patients with drug-eluting stents (DES) is a significant problem in medical practice, particularly in the perioperative period. We report a case of an 87-year-old man with a medical history of hypertension, coronary artery disease and chronic atrophic gastritis. Very late thrombosis of a sirolimus-eluting stent occurred 1207 days after implantation, seven months after discontinuation of clopidogrel, and the interruption of aspirin 13 days in preparation of an elective endoscopic gastrointestinal procedure presented with acute myocardial infarction. The patient was treated with thrombectomy and successfully revascularized with superimposition of two sirolimus-eluting stents. Medications administered in the catheterization laboratory included low molecular weight heparin and nitroglycerin. Flow was defined as grade 2 according to the thrombolysis in myocardial infarction scale. Electrocardiogram after the procedure revealed persistent, but decreased, ST-segment elevation in the anterolateral leads. The patient recovered and was discharged on aspirin and clopidogrel indefinitely. There was no cardiac event during the two year follow-up period. This case underlines the importance of maintaining the balance of thrombosis and bleeding during perioperation of non-cardiac procedure and the possible need for continuation of aspirin therapy during periendoscopic procedures among patients with low bleeding risks who received DES.
    Journal of Geriatric Cardiology 09/2014; 11(3):274-7. DOI:10.11909/j.issn.1671-5411.2014.03.006 · 1.40 Impact Factor
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