May 15, 2021 — 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 (...
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.
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.
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.
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.
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.