Antiplatelet and Anticoagulation Therapies

This channel includes news and new technology innovations for cardiovascular pharmaceutics. This includes antiplatelet agents, anticoagulation drugs, international normalized ratio (INR) testing, oral anticoagulants, IV administered drugs such as Heprin, and dual antiplatelet therapy (DAPT). The most commonly used anticoagulant is warfarin, which available in generic form at a low cost. However, it has a narrow therapeutic window and its effectiveness is altered by food containing vitamin K. To regulate warfarin, regular INR testing is needed. The newer anticoagulation drugs are referred to as novel oral anticoagulant (NOAC). However, since some of these drugs are now more than six years old, they are commonly referred to as non-vitamin K oral anticoagulant (NOAC), and the newest term, direct oral anticoagulant (DOAC). NOAC or DOAC agents have much larger therapeutic windows, do not require INR testing. Aspirin and clopidogrel (Plavix) are the most commonly used antiplatelet agents for the prevention of heart attacks and stroke. They are often prescribed together as DAPT.

The anticoagulant rivaroxaban (Xarelto), in addition to low-dose aspirin, significantly reduced the occurrence of total severe events of the heart, limb or brain and issues related to other vascular complications in patients with symptomatic peripheral artery disease (PAD) who underwent lower extremity revascularization. The findings from the VOYAGER PAD trial were presented at the American College of Cardiology (ACC) 2021 Scientific Session.
News | Peripheral Artery Disease (PAD) | May 17, 2021
May 17, 2021 — The anticoagulant rivaroxaban (Xarelto), in addition to low-dose aspirin, significantly reduced the...
The ADAPTABLE trial found no significant differences in cardiovascular events or major bleeding in patients with pre-existing cardiovascular disease who were taking 81 milligrams (mg) baby aspirin, versus 325 mg of daily aspirin. Getty Images #ACC #ACC21 #ACC2021

The ADAPTABLE trial found no significant differences in cardiovascular events or major bleeding in patients with pre-existing cardiovascular disease who were taking 81 milligrams (mg) baby aspirin, versus 325 mg of daily aspirin. Getty Images

News | Antiplatelet and Anticoagulation Therapies | May 15, 2021
May 15, 2021 — The ADAPTABLE trial found no significant differences in cardiovascular events or major bleeding in...
An Edward Lifesciences Sapien TAVR valve during an implant procedure on angiography. There are still questions on how to best anticoagulate TAVR patients and the ATLANTIS study found Eloquis is not a good solution.

An Edward Lifesciences Sapien TAVR valve during an implant procedure on angiography. There are still questions on how to best anticoagulate TAVR patients and the ATLANTIS study found Eliquis is not a good solution.

News | Structural Heart | May 15, 2021
May 15, 2021 — The anticoagulant apixaban (Eliquis) was not superior to standard of care following transcatheter aortic...
A Chinese registry study found there are higher event rates in patients with shorter dual-antiplatelet therapy (DAPT) after PCI procedures. There has been a lot of movement toward using shorter duration DAPT with newer generation drug-eluting stent technologies, but this study reinforces the need longer DAPT in many patients. The findings were presented as a late-breaking trial at SCAI 2021 today. 

A Chinese registry study found there are higher event rates in patients with shorter dual-antiplatelet therapy (DAPT) after PCI procedures. There has been a lot of movement toward using shorter duration DAPT with newer generation drug-eluting stent technologies, but this study reinforces the need longer DAPT in many patients. The findings were presented as a late-breaking trial at SCAI 2021 today. 

News | Antiplatelet and Anticoagulation Therapies | April 28, 2021
April 28, 2021 — An analysis of the prospective Chinese Fuwai PCI Registry, confirms long-term, dual-antiplatelet...
Comparison showing platelet adhesion to the surface of various coronary artery drug-eluting stents (DES) in a preclinical study that used aspirin only. Abbott said the Xience stent's fluoropolymer is significantly more anti-thrombotic than other DES.[2] 

Comparison showing platelet adhesion to the surface of various coronary artery drug-eluting stents (DES) in a preclinical study that used aspirin only. Abbott said the Xience stent's fluoropolymer is significantly more anti-thrombotic than other DES.[2] 

News | Stents | April 06, 2021
April 6, 2021 — Abbott today announced its Xience stent has received CE mark in Europe for shorter duration of dual...
Videos | Coronavirus (COVID-19) | April 01, 2021
Behnood Bikdeli M.D., a cardiologist at the Brigham and Women’s Hospital, Harvard Medical School, Boston, offers an...
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can potentiate all 3 sides of Virchow’s Triad of coagulopathy, including endothelial dysfunction, blood flow stasis, and hypercoagulability. Angiotensin-converting enzyme-2 (ACE-2)–dependent viral entry and the virus-induced inflammatory response can lead to endothelial dysfunction. Clotting Prevention in COVID-19 Patients, Thrombosis Prevention in COVID-19 Patients, Preventing blood clots in COVID-19 patients

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can potentiate all 3 sides of Virchow’s Triad of coagulopathy, including endothelial dysfunction, blood flow stasis and hypercoagulability. Angiotensin-converting enzyme-2 (ACE-2)–dependent viral entry and the virus-induced inflammatory response can lead to endothelial dysfunction. Additional figure included in the JACC article.

Feature | Antiplatelet and Anticoagulation Therapies | March 22, 2021 | By Dave Fornell, Editor
A comprehensive review or more than 80 randomized controlled trials (RCTs) investigating how to best manage optimal...
Thrombus formation in the aortic arch in a 46-year-old COVID patients in the ICU. Three trials are underway to find which anticoagulant strategy is best to treat moderate and critically ill patients where COVID-causes venous thrombo-embolism (VTE) is a major cause of complications. Image courtesy of Margarita Revzin et al.

Thrombus formation in the aortic arch in a 46-year-old COVID patients in the ICU. Three trials are underway to find which anticoagulant strategy is best to treat moderate and critically ill patients where COVID-causes venous thrombo-embolism (VTE) is a major cause of complications. Image courtesy of Margarita Revzin et al. 

Feature | Coronavirus (COVID-19) | December 23, 2020
December 23, 2020 — Three clinical trial platforms working together to test the effects of full doses of anticoagulants...
RIVER trial is the largest study assessing the efficacy and safety of the anticoagulant rivaroxaban in patients with an artificial mitral valve to correct an irregular heart rhythm
News | November 18, 2020
November 18, 2020 — The primary results from the RIVER Trial, Rivaroxaban for Valvular Heart disease and Atrial...
Among high-risk, chronic, coronary patients who undergo angioplasty, there were no additional benefits from ticagrelor compared to the current standard of care clopidogrel. #AHA #AHA20 #AHA2020
News | Cath Lab | November 16, 2020
November 16, 2020 — The use of the more potent antiplatelet medication ticagrelor (Brilinta) was not superior to...
The American Heart Association, AHA, late-breaking sessions, trials, studies. #AHA #AHA20 #AHA2020
Feature | AHA | November 20, 2020 | Dave Fornell, Editor
Here is a list of the American Heart Association (AHA) late-breaking clinical trial presentations at the 2020 Virtual...
Some of the device technologies discussed in the TCT 2020 late-breaking trial sessions. Top left, the  Medtronic Resolute Onyx stent was the first stent to receive FDA clearance for short duration dual-antiplatelet therapy, which was a big topic and subject of several sessions. Lower left, the Keystone TriGuard 3 TAVR embolic protection device did not demonstrate superiority over TAVR without use of embolic protection. Top right, the Abbott MitraClip. Acurate neo TAVR valve. #TCTconnect #TCT2020

Some of the device technologies discussed in the TCT 2020 late-breaking trial sessions. Top left, the Medtronic Resolute Onyx stent was the first stent to receive FDA clearance for short duration dual-antiplatelet therapy, which was a big topic and subject of several sessions. Lower left, the Keystone TriGuard 3 TAVR embolic protection device did not demonstrate superiority over TAVR without use of embolic protection. Top right, the Abbott MitraClip was the subject of two studies, including use to aid heart transplant patients. Bottom right, the Boston Scientific Acurate neo TAVR valve performed below the Sapien 3 and CoreValve Evolut.

Feature | TCT | October 29, 2020 | Dave Fornell, Editor
Here are some of the key takeaways from the late-breaking interventional cardiology and structural heart trials...
The Watchman FLX will be tested in the CHAMPION-AF trial looks at next-generation transcatheter LAA device as treatment alternative to NOACs for broader population of patients with non-valvular atrial fibrillation.
News | Atrial Fibrillation | October 29, 2020
Oct. 29, 2020 — Boston Scientific initiated the CHAMPION-AF clinical trial to evaluate the safety and efficacy of the...
Videos | Antiplatelet and Anticoagulation Therapies | October 19, 2020
The COMPARE CRUSH Trial looked at the effect of pre-hospital crushed prasugrel tablets in patients with STEMI planned...
Videos | Antiplatelet and Anticoagulation Therapies | October 19, 2020
Roxana Mehran, M.D., and Marco Valgimiggle, M.D., present the results of the Xience 90/28 trials that evaluated the use...