Tag Archives: prasugrel

Background Thrombus formation in the coronary tree is the principal cause of acute coronary syndromes (ACS).1 Following plaque rupture or erosion, platelets adhere to exposed ligands (collagen, von Willebrand factor [vWF]) under high-flow conditions and this leads to platelet activation. Following platelet adhesion and activation, multiple agonists are secreted, including thromboxane A2 (TXA2) and adenosine diphosphate (ADP). TXA2 further activates platelets and ADP amplifies and sustains platelets’ activation, particularly through platelet P2Y12 receptors.2 In view of the pivotal role of platelets in arterial thrombosis, blocking TXA2 pro

The National Institute for Health and Care Excellence (NICE) has said that thousands of people with atrial fibrillation (AF) could be prevented from having strokes, disability or death if its new guidance is followed. It says many patients with AF are not being appropriately anticoagulated and highlights how there has not been widespread uptake of novel oral anticoagulant drugs (NOACs) which were approved by NICE in 2012. Clinical guideline 180 published in June 2014 updates and replaces the 2006 NICE clinical guideline 36. The full guidance can be found at http://www.nice.org.uk/guidance/CG180 NICE Chair, Professor David Haslam writes on the

WOEST: aspirin not required for stent patients on oral anticoagulants  A strategy of using clopidogrel as a single antiplatelet drug for patients receiving a drug-eluting stent who are also taking an oral anticoagulant appears safe and can reduce bleeding, the results of the WOEST study suggest. How to treat patients on anticoagulation when they receive a stent is fraught with difficulty as giving the normal dual antiplatelet therapy with aspirin and clopidogrel means they will be taking three anti-clotting agents which could increase bleeding complications to a dangerous level. But no randomised clinical trials have ever investigated whethe

UK cholesterol awareness low Millions of people in the UK hold incorrect beliefs about the risks of cardiovascular disease (CVD), according to HEART UK research. The research, which tested 1,177 people on their knowledge and concerns about high cholesterol, revealed that more than 40% of respondents wrongly thought that raised cholesterol resulted from drinking too much, while almost 60% did not know that the condition can be inherited. Almost half the population have never had a cholesterol check and only 2% of those surveyed named high cholesterol as their biggest health concern. The top health worry for people was cancer, even though CVD i

Highlights of this year’s European Society of Cardiology Congress, held in Stockholm, Sweden, from August 28th to September 1st included a new drug which benefits heart failure by slowing heart rate, and more exciting results from oral compounds that could replace warfarin in various indications. Highlights of this year’s European Society of Cardiology Congress, held in Stockholm, Sweden, from August 28th to September 1st included a new drug which benefits heart failure by slowing heart rate, and more exciting results from oral compounds that could replace warfarin in various indications. SHIFT: ivabradine shows benefit in heart failure

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

Prasugrel, which will be marketed in Europe as Efient“, will be the first major competitor to clopidogrel, which has a much broader range of indications and is one of the world’s best selling pharmaceuticals. Prasugrel is a more potent antiplatelet agent than clopidogrel and is not thought to be associated with so much variability as clopidogrel. The increased antiplatelet potency of prasugrel would be expected to translate into a higher efficacy in preventing ischaemic events, but also a higher risk of bleeding. This is exactly what was seen in the large-scale TRITON-TIMI 38 trial, on which the approval of prasugrel is based. In the

Prasugrel lowers events but increases bleeding compared with clopidogrel in PCI patients The new antiplatelet agent, prasugrel, reduced ischaemic events compared with clopidogrel but at the cost of an increase in major bleeding in the TRITON-TIMI 38 trial in acute coronary syndrome (ACS) patients scheduled for percutaneous coronary intervention (PCI). Overall mortality did not differ significantly between the two groups. In the study, which has also been published in the New England Journal of Medicine, prasugrel prevented 23 myocardial infarctions (MIs) for every 1,000 patients treated but caused an excess of six non-CABG (coronary artery by