#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Antiaggregation treatment and drug coated stents in 2007


Authors: J. Špinar 1;  J. Vítovec 2
Authors‘ workplace: Interní kardiologická klinika LF MU a FN Brno pracoviště Bohunice 1;  I. interní kardioangiologická klinika LF MU a FN U svaté Anny, Brno 2
Published in: Kardiol Rev Int Med 2007, 9(4): 247-250
Category: Editorial

Overview

Antiaggregation treatment and drug coated stents in 2007. Antiaggregation treatment is the basis for therapy after surgical intervention, especially in the coronary system, with or without stent implant. The results of the CHARISMA study raised a certain amount of caution. The study monitored patients with proven cardiovascular disease (secondary prevention) or with a high cardiovascular risk (primary prevention). The addition of clopidogrel to standard treatment by acetylsalicylic acid (ASA) did not improve the prognosis. The occurrence of the primary objective – the 1st myocardial infarction, cerebrovascular event and cardiovascular death – was similar in both the groups, and the only decrease recorded was from 7.9 % to 6.9 % (p – 0.046) in the secondary prevention primary objective. The entire year 2006 was marked by the discussion about the safety of coated stents (DES) and about the necessary length of antiaggregation therapy after their implantation. In early 2007, registers from different countries occurred pointing to higher rates of thromboses and deaths in patients with DES. The explanation for this surprising finding is linked with premature discontinuation of dual antiaggregation (ASA + clopidogrel). We provide the official stand of the European Society of Cardiology, American Heart Association and the Ministry of Health of the Czech Republic concerning antiaggregation treatment in 2007.

Keywords:
ASA – clopidogrel – mortality – bleeding – thrombosis


Sources

1.Antithrombotics Trialist´s Collaboration. Collaborative metaanalysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction and stroke in high risk patiens. BMJ 1999; 318: 759-764.

2.Antithrombotic Trialists Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71-86.

3.Bhat DL, Fox KA, Hacke W et al. Clopidogrel and asoirin versus aspirin alone for the prevention of atherotrombotic events. NEJM 2006; 354: 1706-1717.

4.Pfeffer MA, Jarcho JA. The charisma subgroups and the subgroups of CHARISMA. NEJM 2006; 354: 1744-1746.

5.Popma JJ, Weiner B, Cowley Mj et al. FDA Advisory Panel on the safety and efficacy of drug eluting stents. www/fda.gov/ohrns/dockets/ac

6.Pfistere M, Bruner L, Buser P et al. Late clinical events after clopidogrel discontinuation may limit the benefit of drug eluting stents an observational study of drug eluting versus bare metal stents. JACC 2006; 48: 88-91.

7.Schuman M. Debating the risk of drug eluting stents. NEJM 2007; 356(4): 325-328.

8.Western Denmark Heart Registr, i2 Summit ACC 2007.

9.Grines CL, Bonow RO, Casey DE jr et al. Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents. J Am Coll Cardiol 2007; 49; 734-739.

10.Silber S, Albertson P, Aviles F et al. Guidelines for percutaneus coronary interventions. EHJ 2005; 26: 804-847.

Labels
Paediatric cardiology Internal medicine Cardiac surgery Cardiology
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#