Tag Archives: antiplatelet therapy

Background, epidemiology and rationale for the COMPASS study One quarter of all deaths in the UK in 2017 occurred as a result of diseases of the heart and circulation.1 One in seven men and one in twelve women died from coronary heart disease (CHD).1 The presence of CHD doubles the risk of stroke,2 and more than 100,000 strokes occur in the UK each year.1 Although the mortality rate from circulatory diseases is declining due to advances in treatment,1,3 more than 100,000 deaths resulted from CHD or stroke combined in the UK each year.1 CHD and stroke are the two leading causes of death worldwide.4 Circulatory disease is also associated with a

Introduction In recent years, the recreational use of synthetic cannabinoids has been gaining global popularity.1-5 Case reports have emerged associating these compounds with a number of adverse effects, including: embolic-appearing ischaemic strokes,6 seizures7 and acute kidney injury.8 In addition, myocardial infarction (MI) has been associated with synthetic cannabinoid use in teenagers.9,10 However, no cases have demonstrated abnormal coronary angiography. There are numerous synthetic cannabinoids, including JWH-018, JWH-073, HU-210, CP 47,497, JWH-081, JWH-122, JWH-210, and newer compounds are regularly being developed.4 A proportion of

Introduction Developments along the way have included better patient selection, improved peri-procedural management of patients and, with newer-generation drugs and devices, better results. Recent hurdles have been confronted, including left main stem disease, complex bifurcation lesions and total chronic occlusions. Similarly, primary percutaneous coronary intervention (PCI) has become the treatment of choice in acute myocardial infarction. Challenges remain, however, including restenosis. The fine balance between thrombosis and haemostasis demands that we provide more effective and predictable antiplatelet strategies to optimise risk reduct

Introduction While primary PCI, rather than thrombolysis, is now the reperfusion treatment of choice for STEMI, the majority of patients coming for revascularisation in the UK have stable coronary disease or NSTE-ACS. In the treatment of NSTE-ACS, first principles involve the selection of patients for diagnostic angiography followed by either PCI or coronary artery bypass grafting (CABG). Rates of PCI are increasing annually in the UK, which, in part, is a reflection of greater awareness of coronary artery disease, its earlier diagnosis and treatment in the ageing population. This section looks at coronary intervention in general, how PCI act

Introduction The discovery of the thienopyridines, or ADP receptor antagonists, led to the development of more effective oral antiplatelet agents. Trials assessed dual antiplatelet therapy in high-risk patients versus aspirin alone and the significant benefits observed have resulted in dual antiplatelet therapy becoming a mainstay of treatment. As expected with more potent dual therapy, there is always a fine balance between prevention of thrombosis and bleeding risk. There are still many challenges to overcome. Many patients, such as those with diabetes or with a previous stent thrombosis, are at high risk for further infarction, indicating

Introduction The use of drug-eluting stents (DES) has increased exponentially in recent years with a significant improvement in the rates of re-stenosis, target lesion and target vessel revascularisation.1-3 There appears to be little difference in short- to medium-term safety compared with bare metal stenting (BMS).4 Coronary thrombosis after stent implantation is well recognised, resulting in acute myocardial infarction and marked adverse outcome. Typically, it happens in the first 3–10 days after the procedure leading almost always to an acute myocardial infarction and not uncommonly to death. Late (>6 months) stent thrombosis is rare

Introduction Stent thrombosis (ST) is a potentially life-threatening complication of coronary artery stent placement (percutaneous coronary intervention [PCI]). Concern about the incidence of ST is greatest in patients treated with drug-eluting stents (DES), in whom some evidence suggests there is a higher incidence than for bare metal stents (BMS).1–3 Recently reported meta-analyses from collections of randomised studies comparing BMS with either Cypher® or Taxus® DES have been interpreted as confirming this increase in risk for these drug-eluting devices.4 It is likely that ST is multi-factorial in its aetiology since evidence demonstra

No content available

No content available