RESUMO
Direct oral anticoagulants (DOACs) are widely used for the prevention of stroke in nonvalvular atrial fibrillation, treatment of deep venous thrombosis and pulmonary embolism, and as prophylaxis after hip and knee surgery after approval by the Food and Drug Administration. In the last decade, DOACs were studied for various indications; this review is focused on rivaroxaban, a factor Xa inhibitor, which is used in an expanded evidence-based fashion for coronary artery disease, peripheral artery disease, heart failure, malignancy, and prophylaxis of deep venous thrombosis in acute medical illnesses.
Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Inibidores do Fator Xa/administração & dosagem , Rivaroxabana/administração & dosagem , Doenças Cardiovasculares/diagnóstico , Tomada de Decisão Clínica , Inibidores do Fator Xa/efeitos adversos , Hemorragia/induzido quimicamente , Humanos , Seleção de Pacientes , Fatores de Risco , Rivaroxabana/efeitos adversos , Resultado do TratamentoRESUMO
Current guidelines recommend dual antiplatelet therapy (DAPT), which includes aspirin and a platelet P2Y(12) adenosine diphosphate (ADP) receptor antagonist, for treatment of patients with acute coronary syndrome and following percutaneous coronary intervention (PCI). Although DAPT significantly reduces stent thrombosis and major adverse cardiovascular events (MACE), there is considerable interindividual variability in the degree of platelet inhibition achieved with the most widely used ADP receptor antagonist, clopidogrel, and high on-treatment platelet activity in the setting of clopidogrel therapy (hyporesponsiveness) is associated with increased adverse cardiovascular events following PCI. Personalized tailoring of antiplatelet therapy guided by patient management algorithms and/or platelet function testing has the potential to reduce MACE and stent thrombosis. This article outlines specific algorithms for using potent new antiplatelet agents, such as prasugrel and ticagrelor, and platelet function "test and treat-to-target" strategies to reduce adverse cardiovascular events following PCI.
Assuntos
Angioplastia Coronária com Balão , Plaquetas/efeitos dos fármacos , Doenças Cardiovasculares/prevenção & controle , Monitoramento de Medicamentos/métodos , Inibidores da Agregação Plaquetária/uso terapêutico , Testes de Função Plaquetária , Adulto , Idoso de 80 Anos ou mais , Algoritmos , Angioplastia Coronária com Balão/efeitos adversos , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Resultado do TratamentoRESUMO
The Phase I clinical study was designed to assess the safety and feasibility of a dose escalating intracoronary infusion of autologous bone marrow (BM)-derived CD133+ stem cell therapy to the patients with chronic total occlusion (CTO) and ischemia. Nine patients were received CD133+ cells into epicardial vessels supplying collateral flow to areas of viable ischemic myocardium in the distribution of the CTO. There were no major adverse cardiac events (MACE), revascularization, re-admission to the hospital secondary to angina, or acute myocardial infarction (AMI) for the 24-month period following cellular infusion. In addition, there were no periprocedural infusion-related complications including malignant arrhythmias, loss of normal coronary blood flow or acute neurologic events. Cardiac enzymes were negative in all patients. There was an improvement in the degree of ischemic myocardium, which was accompanied by a trend towards reduction in anginal symptoms. Intracoronary infusion of autologous CD133+ marrow-derived cells is safe and feasible. Cellular therapy with CD133+ cells to reduce anginal symptoms and to improve ischemia in patients with CTO awaits clinical investigation in Phase II/III trials.