1,721,008 research outputs found
Antithrombotic therapy in patients with acute coronary syndromes: a balance between protection from ischemic events and risk of bleeding
No full textAntithrombotic therapy in patients with acute coronary syndromes: a balance between protection from ischemic events and risk of bleeding
No full textPlatelet activation plays a primary role in the pathogenesis of acute coronary syndromes (ACS); thus, anti-thrombotic therapy with aspirin and clopidogrel represents the mainstay of treatment in those patients. However, low clopidogrel response has become a contemporary issue in interventional cardiology, increasing the risk of ischemic events and significantly worsening short- and long-term prognosis after coronary stenting. Alternative approaches to overcome this phenomenon have been investigated as well as increase in the loading and maintenance clopidogrel doses, reloading patients already on chronic therapy, use of newer and more effective antiplatelet agents. Otherwise a more aggressive antiplatelet treatment may lead to possible increase in bleeding complications. A strategy of an individualized antiplatelet therapy according to point-of-care platelet function tests may represent the optimal approach to balance both ischemic and hemorrhagic risk
Platelet function and inhibition in ischemic heart disease
No full textPlatelets play an important role in the pathogenesis of thrombosis, the most common cause for the development of acute coronary syndromes such as complications occurring during percutaneous coronary intervention. Platelets act with a multiple step mechanism, in which different surface molecules are involved representing important therapeutic targets of antiplatelet agents. Despite clopidogrel efficacy which has been demonstrated in several studies, recurrent ischemic events remain considerably high in patients on treatment due to low clopidogrel responsiveness, a phenomenon influenced by environmental, clinical, and genetic factors. New P2Y12 blockers such as prasugrel and ticagrelor have been successfully introduced in clinical practice, whereas cangrelor, with a rapid offset and reversible platelet inhibition, may represent a useful bridging therapy in patients undergoing surgery. Moreover, the simultaneous inhibition of thrombin platelet aggregation by protease-activated receptor inhibitors may be an adjunctive approach in patients with coronary artery disease
Influence of platelet reactivity on clinical outcome of patients with stable coronary artery disease
No full textPercutaneous coronary interventions and statin therapy
No full textLipid lowering therapy with statins reduces the risk of cardiovascular events in patients with coronary artery disease. Recent in vitro and in vivo studies demonstrated LDL-independent action of this class of drugs, which appears in modulating endothelial function, inflammation and thrombosis. Periprocedural myocardial infarction and contrast induced nephropathy after percutaneous coronary intervention (PCI), associated with worse outcome on short and long term follow-up, are both complications related to inflammatory pathogenetic mechanisms. Randomized studies showed a beneficial effect of short-term statin pretreatment in reducing peri-procedural cardiac markers release in patients undergoing PCI. In fact, statin therapy before elective PCI reduced periprocedural myocardial infarction in patients with stable angina. Furthermore, an acute loading with high-dose atorvastatin prevented myocardial damage in patients with acute coronary syndromes undergoing early PCI (<48 hours). In patients already on chronic statin therapy, a reload with high dose statin was associated with a significant improvement on 30-day cardiac outcome. Finally, statin therapy at the time of PCI significantly decreased the incidence of contrast-induced nephropathy. All these evidences support an "upstream administration"of short-term, high-dose statins in all patients undergoing PCI, in order to achieve pleiotropic, LDL-independent effects of these drugs
Caratteristiche microbiologiche delle acque grigie ed implicazioni per la salute pubblica
No full textGli Autori descrivono le principali caratteristiche microbiologiche delle acque grigie e le evidenze di rischio infettivo associato al riuso.
Le acque grigie veicolano concentrazioni significative di microrganismi patogeni che richiedono accurati trattamenti di bonifica prima dell’uso. Il rispetto dei limiti previsti dalla normativa italiana si associa ad una probabilità di contrarre infezioni batteriche e/o virale molta bassa ed inferiore a 10-5 e 10-9 casi/anno. Rimane aperto il problema delle infezioni parassitarie, a causa della loro resistenza ai trattamenti di bonifica in uso
Influence of Platelet Reactivity on Outcome of Patients With Acute Myocardial Infarction Undergoing Primary Angioplasty
No full textPercutaneous coronary interventions and statin therapy
No full textLipid lowering therapy with statins reduces the risk of cardiovascular events in patients with coronary artery disease. Recent in vitro and in vivo studies demonstrated LDL-independent action of this class of drugs, which appears in modulating endothelial function, inflammation and thrombosis. Periprocedural myocardial infarction and contrast induced nephropathy after percutaneous coronary intervention (PCI), associated with worse outcome on short and long term follow-up, are both complications related to inflammatory pathogenetic mechanisms. Randomized studies showed a beneficial effect of short-term statin pretreatment in reducing peri-procedural cardiac markers release in patients undergoing PCI. In fact, statin therapy before elective PCI reduced periprocedural myocardial infarction in patients with stable angina. Furthermore, an acute loading with high-dose atorvastatin prevented myocardial damage in patients with acute coronary syndromes undergoing early PCI (<48 hours). In patients already on chronic statin therapy, a reload with high dose statin was associated with a significant improvement on 30-day cardiac outcome. Finally, statin therapy at the time of PCI significantly decreased the incidence of contrast-induced nephropathy. All these evidences support an "upstream administration" of short-term, high-dose statins in all patients undergoing PCI, in order to achieve pleiotropic, LDL-independent effects of these drugs
Coronary stenting in patients with depressed left ventricular function: Acute and long-term results in a selected population
No full textPercutaneous coronary angioplasty (PTCA) in patients with depressed left ventricular ejection fraction (LVEF) is associated with increased acute and late mortality; in contrast to plain PTCA, results of stenting in these patients have not been characterized. To assess the current outcome of stenting in patients with LV dysfunction, results from 80 patients procedures were analyzed. Intervention for acute myocardial infarction (MI) was excluded; 21% of patients had unstable angina and 30% had a recent MI. Mean LVEF was 40 +/- 9% (range, 25-45%). Multivessel revascularization was done in 25 patients (31%), with a total of 114 lesions treated. Prophylactic intra-aortic balloon pump was used in only two patients. Angiographic and clinical success was achieved in 79/80 patients (99%). There were no in-hospital deaths, one patient (1%) had a non-Q-wave MI, and no patients required emergency bypass surgery (CABG). All patients completed at least 6 months follow-up (mean, 30 +/- 14 months): 64 patients (80%) remained asymptomatic, 4 (5%) had acute MI, and 5 (6%) died. In-stent restenosis occurred in five patients (6%); of these, three required repeat PTCA, three patients (4%) underwent subsequent elective CABG. Including patients with repeat intervention, 67 patients (84%) are clinically improved; actuarial event-free survival was 87% at 56-month follow-up. Thus, stenting in patients with impaired LVEF is associated with excellent outcome and lower mortality than previously reported for balloon angioplasty alone. Whether coronary stenting may be a therapeutic strategy equivalent to surgery in selected patients needs to be investigated in prospective randomized trials. (C) 2003 Wiley-Liss, Inc
Vascular approaches and its potential implications in transcatheter aortic valve implantation
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