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3.
BMC Neurol ; 21(1): 237, 2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167477

RESUMO

BACKGROUND: Studies have suggested that glycoprotein IIb/IIIa antagonists such as tirofiban are beneficial for patients with acute coronary syndromes. However, it is still uncertain about the efficacy and safety of tirofiban in patients with acute ischemic stroke (AIS). METHODS: In this prospective non-randomized study, 255 AIS patients were recruited from 4 comprehensive stroke centers in China between January, 2017 and May, 2018. Among them,169 patients were treated with aspirin plus clopidogrel and 86 patients were treated with tirofiban. The primary functional outcome was the distribution of the 90 days' modified Rankin Scale (mRS). The safety outcomes included the incidence of intracranial hemorrhage (ICH) at discharge and mortality at 3 months. RESULTS: In the propensity score matched cohort, tirofiban alone was noninferior to the dual antiplatelet with regard to the primary outcome (adjusted common odds ratio, 0.97; 95% confidence interval, 0.46 to 2.04; P = 0.93). Mortality at 90 days was 10% in the dual antiplatelet group and 8% in the tirofiban group (adjusted odds ratio 0.75; 95% CI 0.08 to 7.40, p = 0.81). There was no difference of the ICH rate between two groups (adjusted odds ratio 0.44; 95% CI 0.13 to 1.48, p = 0.18). In the inverse probability of treatment weighting-propensity score-adjusted cohort, similar differences were found for functional and safety outcomes. CONCLUSIONS: Our study suggested that tirofiban use appears to be safe as monotherapy in AIS treatment compared with common dual antiplatelet therapy, however, no improvement in functional outcomes was found. TRIAL REGISTRATION: Chinese clinical trial registry, ChiCTR2000034443 , 05/07/2020. Retrospectively registered.


Assuntos
Fibrinolíticos , AVC Isquêmico , Tirofibana , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Aspirina/uso terapêutico , China , Clopidogrel/administração & dosagem , Clopidogrel/efeitos adversos , Clopidogrel/uso terapêutico , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Fibrinolíticos/uso terapêutico , Humanos , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/epidemiologia , AVC Isquêmico/tratamento farmacológico , AVC Isquêmico/mortalidade , Estudos Prospectivos , Tirofibana/administração & dosagem , Tirofibana/efeitos adversos , Tirofibana/uso terapêutico
5.
J Med Case Rep ; 15(1): 323, 2021 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-34158105

RESUMO

INTRODUCTION: Kawasaki disease is a common vasculitis of unknown etiology that occurs mainly in preschool children. It manifests as a self-limited acute febrile illness with other features including extremity changes, cervical lymphadenopathy, oropharyngeal changes, truncal rash, and conjunctivitis. Intestinal involvement is not uncommon, with abdominal pain and vomiting being the most frequently reported symptoms. Intussusception has been described as a manifestation or complication of this disease, but few reports exist in literature. CASE PRESENTATION: A 7-month-old boy of Asian origin who presented with vomiting and passage of bloody mucoid stool was diagnosed with intussusception that was successfully reduced during emergency laparotomy. The baby was discharged home post-surgery following clinical improvement. He was readmitted on the fourth postoperative day with fever, irritability, and diarrhea. He was investigated and treated for presumed intraabdominal sepsis with multiple antibiotics with no improvement. He gradually developed the mucocutaneous features of Kawasaki disease and was treated with intravenous immunoglobulin and aspirin with good outcome. CONCLUSION: Intussusception and Kawasaki disease both commonly occur in children less than 2 years old. It is important to include Kawasaki disease as a differential diagnosis in children of this age who present with an acute febrile illness and gastrointestinal symptoms. A common underlying pathologic process could be contributing to both conditions.


Assuntos
Intussuscepção , Síndrome de Linfonodos Mucocutâneos , Aspirina/uso terapêutico , Pré-Escolar , Febre/etiologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Lactente , Intussuscepção/etiologia , Intussuscepção/cirurgia , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico
6.
Cochrane Database Syst Rev ; 5: CD003336, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-34002371

RESUMO

BACKGROUND: People with chronic heart failure (HF) are at risk of thromboembolic events, including stroke, pulmonary embolism, and peripheral arterial embolism; coronary ischaemic events also contribute to the progression of HF. The use of long-term oral anticoagulation is established in certain populations, including people with HF and atrial fibrillation (AF), but there is wide variation in the indications and use of oral anticoagulation in the broader HF population. OBJECTIVES: To determine whether long-term oral anticoagulation reduces total deaths and stroke in people with heart failure in sinus rhythm. SEARCH METHODS: We updated the searches in CENTRAL, MEDLINE, and Embase in March 2020. We screened reference lists of papers and abstracts from national and international cardiovascular meetings to identify unpublished studies. We contacted relevant authors to obtain further data. We did not apply any language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCT) comparing oral anticoagulants with placebo or no treatment in adults with HF, with treatment duration of at least one month. We made inclusion decisions in duplicate, and resolved any disagreements between review authors by discussion, or a third party. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion, and assessed the risks and benefits of antithrombotic therapy by calculating odds ratio (OR), accompanied by the 95% confidence intervals (CI). MAIN RESULTS: We identified three RCTs (5498 participants). One RCT compared warfarin, aspirin, and no antithrombotic therapy, the second compared warfarin with placebo in participants with idiopathic dilated cardiomyopathy, and the third compared rivaroxaban with placebo in participants with HF and coronary artery disease. We pooled data from the studies that compared warfarin with a placebo or no treatment. We are uncertain if there is an effect on all-cause death (OR 0.66, 95% CI 0.36 to 1.18; 2 studies, 324 participants; low-certainty evidence); warfarin may increase the risk of major bleeding events (OR 5.98, 95% CI 1.71 to 20.93, NNTH 17). 2 studies, 324 participants; low-certainty evidence). None of the studies reported stroke as an individual outcome. Rivaroxaban makes little to no difference to all-cause death compared with placebo (OR 0.99, 95% CI 0.87 to 1.13; 1 study, 5022 participants; high-certainty evidence). Rivaroxaban probably reduces the risk of stroke compared to placebo (OR 0.67, 95% CI 0.47 to 0.95; NNTB 101; 1 study, 5022 participants; moderate-certainty evidence), and probably increases the risk of major bleeding events (OR 1.65, 95% CI 1.17 to 2.33; NNTH 79; 1 study, 5008 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Based on the three RCTs, there is no evidence that oral anticoagulant therapy modifies mortality in people with HF in sinus rhythm. The evidence is uncertain if warfarin has any effect on all-cause death compared to placebo or no treatment, but it may increase the risk of major bleeding events. There is no evidence of a difference in the effect of rivaroxaban on all-cause death compared to placebo. It probably reduces the risk of stroke, but probably increases the risk of major bleedings. The available evidence does not support the routine use of anticoagulation in people with HF who remain in sinus rhythm.


Assuntos
Anticoagulantes/uso terapêutico , Cardiomiopatia Dilatada/complicações , Insuficiência Cardíaca/complicações , Tromboembolia/prevenção & controle , Administração Oral , Anticoagulantes/efeitos adversos , Aspirina/uso terapêutico , Doença Crônica , Insuficiência Cardíaca/mortalidade , Frequência Cardíaca , Hemorragia/induzido quimicamente , Humanos , Efeito Placebo , Placebos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/etiologia , Tromboembolia/mortalidade , Varfarina/efeitos adversos , Varfarina/uso terapêutico
7.
BMJ Case Rep ; 14(5)2021 May 19.
Artigo em Inglês | MEDLINE | ID: covidwho-1236430

RESUMO

This is a case report of central retinal vein occlusion (CRVO) associated with COVID-19 treated with oral aspirin therapy. A 56-year-old woman reported decreased vision in her left eye. Her left eye vision was 6/18, N10. Anterior segment was within normal limits. Left eye fundus was suggestive of CRVO and macular oedema. Optical coherence tomography showed cystoid macular oedema and neurosensory detachment. Blood work-up revealed elevated D-dimer levels and erythrocyte sedimentation rate (ESR). She was started on treatment with low-dose aspirin 150 mg/day. After 1 month, her vision improved to 6/6, N6. Left eye fundus showed reduced retinal haemorrhages and complete resolution of macular oedema. Her repeat blood work-up showed reduced D-dimer and ESR levels. The patient was asked to be reviewed after 3 months. This case highlights that specific treatment for reducing the hypercoagulable state caused by COVID-19 with oral aspirin therapy can result in complete resolution of CRVO macular oedema.


Assuntos
COVID-19 , Oclusão da Veia Retiniana , Aspirina/uso terapêutico , Feminino , Angiofluoresceinografia , Humanos , Pessoa de Meia-Idade , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/tratamento farmacológico , SARS-CoV-2 , Tomografia de Coerência Óptica
8.
Am J Cardiol ; 150: 47-54, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34011436

RESUMO

Controversy remains regarding the optimal antiplatelet regimen in patients with acute coronary syndrome (ACS). This study sought to investigate the efficacy and safety of P2Y12 inhibitor monotherapy compared with conventional dual antiplatelet therapy (DAPT) and aspirin monotherapy in patients with ACS undergoing percutaneous coronary intervention. Data on 4,453 patients were pooled from SMART-DATE and SMART-CHOICE randomized trials. Antiplatelet therapy regimens were categorized as P2Y12 inhibitor monotherapy (P2Y12 inhibitor monotherapy after 3-month DAPT), conventional DAPT (12-month or longer DAPT), and aspirin monotherapy (aspirin monotherapy after 6-month DAPT). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE, a composite of all-cause death, myocardial infarction, and stroke). Inverse-probability of treatment-weighted (IPTW) analysis was performed. At 1 year, patients in the P2Y12 inhibitor monotherapy had a comparable risk of MACCE compared with those in the conventional DAPT (IPTW-adjusted hazard ratio [HR], 0.655; 95% confidence interval [CI] 0.393 to 1.094; p = 0.106), and tended to have a lower risk of MACCE than those in the aspirin monotherapy (IPTW-adjusted HR, 0.606; 95% CI, 0.347 to 1.058; p = 0.078). The adjusted hazard for the Bleeding Academic Research Consortium (BARC) type 2 to 5 bleeding was significantly lower in P2Y12 inhibitor monotherapy than in conventional DAPT (IPTW-adjusted HR, 0.341; 95% CI, 0.190 to 0.614; p < 0.001) and in aspirin monotherapy (IPTW-adjusted HR, 0.359; 95% CI, 0.182 to 0.708; p = 0.003). In conclusion, among patients with ACS undergoing PCI, P2Y12 inhibitor monotherapy after 3-month DAPT reduced risk of bleeding compared with conventional DAPT and aspirin monotherapy after 6-month DAPT without increasing MACCE.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Aspirina/uso terapêutico , Terapia Antiplaquetária Dupla , Inibidores da Agregação Plaquetária/uso terapêutico , Síndrome Coronariana Aguda/cirurgia , Idoso , Clopidogrel/uso terapêutico , Stents Farmacológicos , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Cloridrato de Prasugrel/uso terapêutico , Ticagrelor/uso terapêutico
9.
Ann Palliat Med ; 10(4): 4632-4641, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33966411

RESUMO

BACKGROUND: Meta-analysis was used to evaluate the efficacy and safety of aspirin combined with letrozole in the treatment of polycystic ovary syndrome (PCOS). METHODS: Through comprehensive searches of the China Knowledge Network (CNKI), the VIP database (VIP), the Wanfang database, the China Biomedical Database (CBM), PubMed, EMBASE, and the Cochrane Library, the clinical randomized controlled trials (RCTs) published on aspirin combined with letrozole in the treatment of PCOS were collected. According to the inclusion and exclusion criteria, the included studies were screened and quality evaluated, and RevMan 5.3 software was used for meta-analysis. RESULTS: A total of 10 RCTs and 948 patients with PCOS were included. Meta-analysis results showed that compared with letrozole monotherapy, aspirin combined with letrozole could significantly increase the thickness of the endometrium [MD=1.98, 95% CI: 1.63-2.34, P<0.00001], cervical mucus scores (MD =1.65, 95% CI: 1.32-1.98, P<0.00001), the ovulation rate (OR=3.50, 95% CI: 2.08-5.91, P<0.00001), the number of mature follicles (MD=0.65, 95% CI: 0.51-0.78, P<0.00001), and the pregnancy rate (OR=3.06, 95% CI: 2.28-4.12, P<0.00001), and significantly reduced the abortion rate (OR=0.20, 95% CI: 0.11-0.38, P<0.00001). There was no statistically significant difference in the incidence of adverse reactions between the 2 groups (OR=0.76, 95% CI: 0.44-1.32, P=0.33). CONCLUSIONS: Aspirin combined with letrozole in the treatment of PCOS is safe and effective. Due to the limitations in the number and quality of the included studies, further verification with multi-center, large-sample, high-quality RCTs is still needed.


Assuntos
Síndrome do Ovário Policístico , Aspirina/uso terapêutico , China , Feminino , Humanos , Letrozol/uso terapêutico , Indução da Ovulação , Síndrome do Ovário Policístico/tratamento farmacológico , Gravidez
10.
Bone Joint J ; 103-B(6 Supple A): 18-22, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34053277

RESUMO

AIMS: The optimal management of an infrapopliteal deep venous thrombosis (IDVT) following total knee arthroplasty (TKA) remains unknown. The risk of DVT propagation and symptom progression must be balanced against potential haemorrhagic complications associated with administration of anticoagulation therapy. The current study reports on a cohort of patients diagnosed with IDVT following TKA who were treated with aspirin, followed closely for development of symptoms, and scanned with ultrasound to determine resolution of IDVT. METHODS: Among a cohort of 5,078 patients undergoing TKA, 532 patients (695 TKAs, 12.6%) developed an IDVT between 1 January 2014 to 31 December 2019 at a single institution, as diagnosed using Doppler ultrasound at the first postoperative visit. Of the entire cohort of 532 patients with IDVT, 91.4% (486/532) were treated with aspirin (325 mg twice daily) and followed closely. Repeat lower limb ultrasound was performed four weeks later to evaluate the status of IDVT. RESULTS: Follow-up Doppler ultrasound was performed on 459/486 (94.4%) patients and demonstrated resolution of IDVT in 445/459 cases (96.9%). Doppler diagnosed propagation of IDVT to the popliteal vein had occurred in 10/459 (2.2%) cases. One patient with an IDVT developed a pulmonary embolus six weeks postoperatively. CONCLUSION: The results of this study demonstrate a low rate of IDVT propagation in patients managed with aspirin. Additionally, no significant bleeding episodes, wound-related complications, or other adverse events were noted from aspirin therapy. Cite this article: Bone Joint J 2021;103-B(6 Supple A):18-22.


Assuntos
Anticoagulantes/uso terapêutico , Artroplastia do Joelho , Aspirina/uso terapêutico , Veia Poplítea , Complicações Pós-Operatórias/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Idoso , Distinções e Prêmios , Feminino , Humanos , Masculino , Ultrassonografia Doppler , Tromboembolia Venosa/diagnóstico por imagem
11.
Curr Cardiol Rep ; 23(6): 67, 2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-33961154

RESUMO

PURPOSE OF REVIEW: The utility of aspirin and statins for primary prevention of atherosclerotic cardiovascular disease remains ambiguous in older adults. Current guidelines and recent data are vague and inconclusive. This review seeks to summarize the landscape of primary prevention of cardiovascular disease in older adults and explore the role of shared decision making. RECENT FINDINGS: Observational data suggest potential benefit of statin therapy in older adults. Aspirin is presently not recommended for primary prevention based on evidence from recent clinical trials. The implementation of shared decision making and decision aids in routine clinical practice remains challenging but may rise in coming years. Clinical trial data on the horizon may aid in solidifying guideline therapy for statin use. However, in the face of uncertainty, shared decision making between provider and patient should be utilized to determine whether pharmacotherapy may benefit older adults. Decision aids are an effective tool to guide this process.


Assuntos
Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases , Idoso , Aspirina/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Tomada de Decisões , Tomada de Decisão Compartilhada , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Prevenção Primária , Incerteza
12.
J Stroke Cerebrovasc Dis ; 30(7): 105800, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33964545

RESUMO

OBJECTIVES: Many studies showed that platelet reactivity testing can predict ischemic events after carotid stenting or ischemic stroke. The aim of our study was to assess the role of early platelet function monitoring in predicting 90-days functional outcome, stent thrombosis and hemorrhagic transformation in patients with ischemic stroke treated with endovascular procedures requiring emergent extracranial stenting. MATERIALS AND METHODS: We performed a retrospective study on consecutive patients with acute anterior circulation stroke admitted to our hospital between January 2015 and March 2020, in whom platelet reactivity testing was performed within 10 days from stenting. Patients were divided according to validated cutoffs in acetylsalicylic acid and Clopidogrel responders and not responders. Group comparison and regression analyses were performed to identify differences between groups and outcome predictors. RESULTS: We included in the final analysis 54 patients. Acetylsalicylic acid resistance was an independent predictor of poor 90 days outcome (OR for modified Rankin scale (mRS) ≤ 2: 0.10 95% CI: 0.02 - 0.69) whereas Clopidogrel resistance was an independent predictor of good outcome (OR for mRS ≤ 2: 7.09 95%CI: 1.33 - 37.72). Acetylsalicylic acid resistance was also associated with increased 90-days mortality (OR: 18.42; 95% CI: 1.67 - 203.14). CONCLUSION: We found a significant association between resistance to acetylsalicylic acid and poor 90-days functional outcome and between resistance to Clopidogrel and good 90-days functional outcome. If confirmed, our results might improve pharmacological management after acute carotid stenting.


Assuntos
Estenose das Carótidas/terapia , Monitoramento de Medicamentos , Procedimentos Endovasculares , AVC Isquêmico/terapia , Inibidores da Agregação Plaquetária/uso terapêutico , Agregação Plaquetária/efeitos dos fármacos , Testes de Função Plaquetária , Idoso , Aspirina/uso terapêutico , Estenose das Carótidas/sangue , Estenose das Carótidas/diagnóstico , Clopidogrel/uso terapêutico , Bases de Dados Factuais , Avaliação da Deficiência , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Hemorragias Intracranianas/induzido quimicamente , AVC Isquêmico/sangue , AVC Isquêmico/diagnóstico , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/efeitos adversos , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Stents , Trombose/sangue , Trombose/etiologia , Trombose/prevenção & controle , Fatores de Tempo , Resultado do Tratamento
13.
BMJ Case Rep ; 14(5)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011649

RESUMO

This is a case report of central retinal vein occlusion (CRVO) associated with COVID-19 treated with oral aspirin therapy. A 56-year-old woman reported decreased vision in her left eye. Her left eye vision was 6/18, N10. Anterior segment was within normal limits. Left eye fundus was suggestive of CRVO and macular oedema. Optical coherence tomography showed cystoid macular oedema and neurosensory detachment. Blood work-up revealed elevated D-dimer levels and erythrocyte sedimentation rate (ESR). She was started on treatment with low-dose aspirin 150 mg/day. After 1 month, her vision improved to 6/6, N6. Left eye fundus showed reduced retinal haemorrhages and complete resolution of macular oedema. Her repeat blood work-up showed reduced D-dimer and ESR levels. The patient was asked to be reviewed after 3 months. This case highlights that specific treatment for reducing the hypercoagulable state caused by COVID-19 with oral aspirin therapy can result in complete resolution of CRVO macular oedema.


Assuntos
COVID-19 , Oclusão da Veia Retiniana , Aspirina/uso terapêutico , Feminino , Angiofluoresceinografia , Humanos , Pessoa de Meia-Idade , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/tratamento farmacológico , SARS-CoV-2 , Tomografia de Coerência Óptica
14.
Curr Opin Cardiol ; 36(4): 390-396, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33973929

RESUMO

PURPOSE OF REVIEW: Antiplatelet therapy is key to reduce systemic and local thrombotic events among patients undergoing percutaneous coronary interventions (PCI). Antiplatelet treatment regimens have been subject to continuous changes over the years, with a dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 inhibitor representing the cornerstone of treatment in these patients. RECENT FINDINGS: The need for less aggressive antithrombotic drugs to prevent local ischemic events with newer generation drug-eluting stent together with the increased understanding of the prognostic relevance of bleeding events in PCI patients, have prompted investigations aimed at identifying antiplatelet treatment regimens associated with a more favorable balance between ischemic and bleeding risks. Several key randomized controlled trials (RCTs) on antiplatelet regimens in patients undergoing PCI have been recently reported resulting in updates in practice guidelines. SUMMARY: This manuscript provides an overview of the advancements in the field deriving from key RCTs on antiplatelet regimens in patients undergoing PCI.


Assuntos
Stents Farmacológicos , Intervenção Coronária Percutânea , Aspirina/uso terapêutico , Quimioterapia Combinada , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
J Cardiothorac Surg ; 16(1): 139, 2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34022927

RESUMO

BACKGROUND: Management of patients treated with Ticagrelor is challenging, as stopping Ticagrelor prior to coronary bypass graft surgery (CABG) may increase the risk of acute stent thrombosis. The aim of the study was to compare bleeding complications in patients treated with ticagrelor combined with acetylsalicylic acid (ASA) versus ASA alone until 1 day before surgery. METHODS: Bleeding complications, defined as the composite of red blood cell transfusion ≥1000 ml, chest drainage ≥2000 ml, and bleeding requiring surgical re-exploration, were compared in 161 patients, with 101 on preoperative acetylsalicylic acid (ASA) alone (group A) and 65 on ticagrelor + ASA (group B). RESULTS: There were no differences in bleeding complications between the two groups (26% vs. 27% in group A and B, respectively), with similar chest drainage in the first 24 h (569 ± 393 ml and 649 ± 427 ml, respectively). CONCLUSIONS: Continuing ticagrelor until coronary artery bypass surgery was not associated with increased bleeding complications, suggesting that continued management with ticagrelor until surgery may be safe.


Assuntos
Aspirina/uso terapêutico , Ponte de Artéria Coronária/efeitos adversos , Inibidores da Agregação Plaquetária/uso terapêutico , Hemorragia Pós-Operatória/etiologia , Ticagrelor/uso terapêutico , Idoso , Drenagem , Quimioterapia Combinada , Transfusão de Eritrócitos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/cirurgia , Estudos Retrospectivos , Stents/efeitos adversos , Cavidade Torácica , Trombose/etiologia , Trombose/prevenção & controle
18.
Clin Appl Thromb Hemost ; 27: 10760296211014592, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33928791

RESUMO

Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) can induce inflammatory and thrombotic complications of pulmonary district (interstitial pneumonia), sometimes evolving toward acute respiratory failure. In adults, Acetylsalicylic Acid (ASA) is widely employed at low doses for primary and secondary prevention of cardiovascular diseases (CVD). Apart their anti-thrombotic effect, low ASA doses also exert an anti-inflammatory action. So, when these are assumed for CVD prevention, could prevent both inflammatory reaction and pro-coagulant tendency of Coronavirus-2019 (COVID-19) infection. In addition, some patients receiving ASA are simultaneously treated with Statins, to correct dyslipidemia. But, for their pleiotropic effects, Statins can also be useful to antagonize pulmonary thrombo-inflammation induced by COVID-19. Thus ASA, with or without Statins, employed for CVD prevention, could be useful to avoid or minimize inflammatory reaction and thrombotic complications of COVID-19. But, further studies performed in a wide range are requested to validate this hypothesis.


Assuntos
Aspirina/uso terapêutico , COVID-19/tratamento farmacológico , SARS-CoV-2/metabolismo , Trombose/prevenção & controle , COVID-19/sangue , COVID-19/complicações , COVID-19/diagnóstico por imagem , Feminino , Humanos , Masculino , Trombose/sangue , Trombose/diagnóstico por imagem , Trombose/etiologia
19.
JAMA ; 325(15): 1545-1555, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33877270

RESUMO

Importance: Acute coronary syndrome (ACS) is a major cause of morbidity and mortality in the United States with an annual incidence of approximately 1 million. Dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel) reduces cardiovascular event rates after ACS. Observations: In 2016, the updated guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) recommended aspirin plus a P2Y12 inhibitor for at least 12 months for patients with ACS. Since these recommendations were published, new randomized clinical trials have studied different regimens and durations of antiplatelet therapy. Recommendations vary according to the risk of bleeding. If bleeding risk is low, prolonged DAPT may be considered, although the optimal duration of prolonged DAPT beyond 1 year is not well established. If bleeding risk is high, shorter duration (ie, 3-6 months) of DAPT may be reasonable. A high risk of bleeding traditionally is defined as a 1-year risk of serious bleeding (either fatal or associated with a ≥3-g/dL drop in hemoglobin) of at least 4% or a risk of an intracranial hemorrhage of at least 1%. Patients at higher risk are 65 years old or older; have low body weight (BMI <18.5), diabetes, or prior bleeding; or take oral anticoagulants. The newest P2Y12 inhibitors, prasugrel and ticagrelor, are more potent, with high on-treatment residual platelet reactivity of about 3% vs 30% to 40% with clopidogrel and act within 30 minutes compared with 2 hours for clopidogrel. Clinicians should avoid prescribing prasugrel to patients with a history of stroke or transient ischemic attack because of an increased risk of cerebrovascular events (6.5% vs 1.2% with clopidogrel, P = .002) and should avoid prescribing it to patients older than 75 years or who weigh less than 60 kg. The ISAR-REACT-5 trial found that prasugrel reduced rates of death, myocardial infarction, or stroke at 1 year compared with ticagrelor among patients with ACS undergoing percutaneous coronary intervention (9.3% vs 6.9%, P = .006) with no significant difference in bleeding. Recent trials suggested that discontinuing aspirin rather than the P2Y12 inhibitor may be associated with better outcomes. Conclusions and Relevance: Dual antiplatelet therapy reduces rates of cardiovascular events in patients with acute coronary syndrome. Specific combinations and duration of dual antiplatelet therapy should be based on patient characteristics-risk of bleeding myocardial ischemia.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Aspirina/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Administração Oral , Aspirina/farmacologia , Doenças Cardiovasculares/prevenção & controle , Clopidogrel/uso terapêutico , Quimioterapia Combinada , Humanos , Cloridrato de Prasugrel/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/farmacologia , Ticagrelor/uso terapêutico
20.
J Stroke Cerebrovasc Dis ; 30(7): 105822, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: covidwho-1179851

RESUMO

There have been limited cases linking SARS-CoV-2 infection with the development of reversible cerebral vasoconstriction syndrome (RCVS). We hereby report a rare case of RCVS in the setting of mild SARS-CoV-2 respiratory infection successfully treated with nimodipine and aspirin. SARS-CoV-2 attacks the ACE2-receptors, which are expressed in various body organs including the lungs, kidneys, and blood vessels. Vasoconstriction can result from down-regulation of the ACE2-receptors that can lead to sympathetic hypertonia of the cerebral blood vessel walls and/or over-activation of the renin-angiotensin axis.


Assuntos
Aspirina/uso terapêutico , COVID-19/complicações , Artérias Cerebrais/efeitos dos fármacos , Nimodipina/uso terapêutico , Vasoconstrição/efeitos dos fármacos , Vasodilatadores/uso terapêutico , Vasoespasmo Intracraniano/tratamento farmacológico , Adulto , COVID-19/diagnóstico , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/fisiopatologia , Feminino , Humanos , Síndrome , Resultado do Tratamento , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/fisiopatologia
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