Stent thrombosis: Role of compliance and nonresponsiveness to antiplatelet therapy
Sinai Center for Thrombosis Research, Baltimore, Maryland, USA.Reviews in cardiovascular medicine (Impact Factor: 0.56). 01/2007; 8 Suppl 1:S19-26.
Percutaneous coronary intervention with drug-eluting stents has revolutionized the management of patients with symptomatic coronary artery disease. Although this strategy significantly reduces the incidence of restenosis and repeat revascularization, concern has been raised about an increased frequency of late stent thrombosis with drug-eluting stents compared with bare-metal stents. The mechanism of stent thrombosis remains unclear, and various hypotheses have been described. Platelets are believed to play a pivotal role in the development of stent thrombosis, with pathological studies demonstrating an abundance of platelets within the occlusive thrombi. Premature discontinuation and nonadherence to antiplatelet therapy are considered important risk factors for late stent thrombosis. Early identification of vulnerable patients and definition of the role of antiplatelet nonresponsiveness in the development of stent thrombosis should be the focus of future diagnostic and therapeutic strategies.
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ABSTRACT: An estimated 71 million individuals in the United States are currently diagnosed with cardiovascular disease (CVD). If untreated, CVD conditions such as systemic hypertension, coronary artery disease, and heart failure will have potentially serious and often fatal outcomes. Numerous clinical trials have established a variety of evidence-based medications that are efficacious in the treatment of CVD. These drugs will be ineffective, however, if patients have trouble adhering to their prescribed regimens. In patients with hypertension or heart failure, or in those who have suffered a myocardial infarction, poor adherence to therapies has been linked to a variety of problems, including poor blood pressure control, rehospitalization, and increased healthcare resource utilization. Both the asymptomatic nature of some forms of CVD and the high pill burden associated with certain therapies have been linked to poor adherence. Reducing pill burden through the use of once-daily formulations has proven valuable in improving adherence to evidence-based therapies. This review will discuss the impact of adherence to prescribed therapies for CVD, outline common barriers to adherence, and demonstrate the value of once-daily dosing regimens for improved patient adherence.
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ABSTRACT: Background LCn-3PUFA comprised of eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) offer cardio-protection involving a decrease in coagulant activity; however the evidence is equivocal. We have previously demonstrated that the acute (24 h) effects and chronic (4 wk) effects of LCn-3PUFA supplementation on platelet aggregation in human subjects are sex-specific. This study investigated the mechanisms of the sex-dependent effects of LCn-3PUFA with 4 weeks supplementation of EPA versus DHA-rich oils on procoagulant and platelet activity in healthy subjects. Design A double-blinded placebo randomised controlled trial was conducted in 94 healthy adults: male (n = 41) and female (n = 53). Platelet coagulation parameters including factors I, II, V, VII, VIII, IX, X, vWF:Ag and endogenous thrombin potential were measured at baseline and 4 weeks post-supplementation with EPA or DHA-rich oil capsules. Results We have previously reported that platelet aggregation is specifically reduced by supplementation with EPA in males, and DHA in females. This sex-specific effect was also observed for decreases in plasma levels of Factor II (−7.9 ± 3.8%, P =0.026), Factor V (−6.5 ± 4.5%, P = 0.022) and vWF:Ag (−7.3 ± 2.1%, P = 0.034), and was most pronounced in males supplemented with EPA. In contrast, DHA mediated reduction in platelet aggregation in females was not accompanied by any significant changes in the coagulation parameters tested. Conclusion Significant interactions between sex and specific LCn-3PUFA exist to reduce procoagulant activity differentially in males versus females and could have profound effects on managing risk of thrombotic disease.
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