Regulation of platelet function by cantharidin via PI3K/Akt/PKC pathway / 中国药理学通报

To investigate the effect of cantharidin ( CTD) on platelet function and the mechanism of anti-platelet aggregation. Methods Washed platelets were collected from the venous blood of healthy volunteers. The effect of CTD on platelet aggregation and release was determined by aggregometer. The CTD concentration was 2.5 ,5 ,10 μmol • L

Interpretation of Acute,Perioperative,and Long-term Antithrombotic Therapy Strategies in the Elderly / 医药导报

In January 2023,the European Society of Cardiology(ESC)Working Group on thrombosis published its 2022 updated consensus document on acute,perioperative,and long-term antithrombotic therapy for the elderly.Since the elderly are often accompanied with multiple organ changes and multiple diseases,the risk of hemorrhagic and ischemic events is increased,and they often take multiple drugs and have poor compliance with treatment,which pose significant challenges to clinical antithrombotic management.This article elaborates on how to assess the risk of thrombosis and bleeding,the treatment strategy of oral antithrombotic drugs,the treatment strategy of parenteral antithrombotic drugs,and the perioperative antithrombotic therapy protocols,with the aim of providing clinicians with references for the treatment of antithrombosis in the elderly.

Application and monitoring of antiplatelet drugs in children with Kawasaki disease / 国际儿科学杂志

Long-term antiplatelet therapy is critical for children with Kawasaki disease.Commonly used antiplatelet drugs have their own advantages and adverse reactions, so they need to be chosen carefully.Some studies have shown that drug resistance may occur in children with Kawasaki disease during antiplatelet therapy, which increases the risk of cardiovascular adverse events, and platelet aggregation function needs to be monitored during medication.This paper reviews the antiplatelet drugs in common use, the drug resistance of antiplatelet drugs and the detection methods of platelet aggregation function in Kawasaki disease, which is helpful to improve the safety of drugs use and reduce the incidence of complications in children.

Roles of Platelets in Tumor Metastasis / 中国生物化学与分子生物学报

Platelets are small anucleated fragments derived from megakaryocytes participating in coagulation and hemostasis. In recent years, more and more experimental and clinical evidences show that platelets also promote tumor metastasis. When tumor cells detach from the primary tumor and access the blood, platelets are the first host cells they encounter. As an important member of tumor metastasis microenvironment, platelets and tumor cells interact and affect each other. On the one hand, tumor cells can regulate the function of platelets by inducing platelets activation and aggregation; on the other hand, platelets can promote tumor metastasis by directly contacting and releasing bioactive mediators. Numerous studies have shown that platelets can promote tumor metastasis through the following approaches: 1. Reducing the shear force-induced damage; 2. Helping tumor cells escape immune surveillance; 3. Promoting tumor cells migration and stationary adhesion in blood vessels; 4. Promoting epithelial-mesenchymal transition of tumor cells; 5. Promoting tumor cell extravasation; 6. Forming a metastatic niche suitable for the survival of tumor cells. Therefore, targeting the interaction between platelets and tumor cells has become a potential tumor treatment strategy. Based on the latest research progress at home and abroad, this paper reviews the roles of platelets in different stages of tumor metastasis and the application of antiplatelet drugs in tumor therapy.

Bleeding after tooth extraction in patients receiving anticoagulation/antiplatelet therapy / 口腔疾病防治

@#Tooth extraction in patients receiving anticoagulation/antiplatelet therapy is often considered contraindicated by many oral and maxillofacial surgeons because of a higher risk of postoperative bleeding. Multiple factors contribute to postoperative bleeding, but there is no consensus. Based on recent literature, this article reviews factors related to bleeding after tooth extraction in patients receiving anticoagulation/antiplatelet therapy. The literature review indicates that patients taking antiplatelet drugs have a lower postoperative bleeding risk than patients taking anticoagulant drugs. Prescription of anticoagulants together with non-steroidal anti-inflammatory drugs, selective serotonin inhibitors or serotonin-norepinephrine inhibitors increases the risk of bleeding, so does preoperative antibiotic use increase. In addition, systemic diseases such as diabetes, history of infection at the extraction site, and greater surgical trauma are associated with a higher risk of postoperative bleeding. At present, it is generally believed that it is safe and feasible to use different hemostatic measures after tooth extraction and to rationally apply different hemostatic measures after surgery. More prospective controlled trials are needed in the future to establish an assessment system for patients undergoing anticoagulation/antiplatelet therapy under different conditions during tooth extraction.

Research progress on the relationship between antiplatelet drugs and cerebral microbleeds / 中华神经科杂志

Cerebral microbleeds (CMBs) are a subclinical terminal microvascular disease in which the blood exudates or leaks out from the tiny blood vessels and the small lesions were formed by the deposition of hemosiderin in the brain tissue. The pathogenesis of cerebral microbleeds is different depending on the location, with lobar CMBs attributed to cerebral amyloid angiopathy (CAA), while cerebrovascular diseases caused by hypertension are an important cause of deep and subtentorium CMBs. The prevalence of CMBs in stroke patients is high, especially in patients with ischemic stroke treated with oral antiplatelet drugs, and long-term (>5 years) treatment may be related to CMBs and intracerebral hemorrhage (ICH) events. At the same time, a certain burden of microbleeds may cause risk of ICH in the future, but whether the bleeding risk of antiplatelet treatment overweighs the clinical benefit of antithrombotic therapy remains unclear. How to better instruct antiplatelet therapy in patients with ischemic stroke warrants further clinical investigations.

Evaluation of Drug Utilization Pattern in Cardiovascular Diseases Using WHO/ INRUD Prescribing Indicators at Cardiology OPD of Tertiary Care Hospitals in South India: A Multicenter Cross-Sectional Study

Objective:Aim of this study is to assess the drug utilization pattern of cardiovascular drugs in cardiology outpatient department (OPD). Methodology:This prospective, multicenter, cross-sectional observational study was conducted at three selected tertiary care hospitals from different regions in South India. A total of 1026 prescriptions of the patients attending cardiology OPD of these selected hospitals 342 each over a period of 12 months was randomly identified and included in this study then critically analysed for WHO/INRUD core prescribing indicators. Results:Medicines prescribed from NLEM were 89.27%, average drugs prescribed was 5, medicinesprescribed by its generic name were 2.33% and encounters with an injection prescribed were 14.52%. Commonly prescribed different class of drugs for CVDs patients were Anti-platelets (67.73%) followed by Statins (62.57%), Beta blockers (49.51%), ACE-inhibitors (40.93%), Angiotensin receptor blockers (30.40%), Calcium channel blockers (30.11%), Nitrates (25.34%), Diuretics (20.56%), Anticoagulants (20.27%), Vasodilators (9.94%) rest of the cardiovascular drugs were prescribed within 0.5-5% only, other class of drugs also prescribed for patients with different comorbidities are Anti-ulcers (69.10%), Opioid analgesics (4.09%), Antacids (3.80%), Anti-emetics and Pro-kinetics (1.85%), a pattern of poly-pharmacy was clearly evident, majority of drugs were prescribed as single drug (86.78%) whereas 13.21% as FDCs. The most commonly prescribed single drug was Aspirin (59.93%) and FDCs were Aspirin + Clopidogrel (40.24%). Anti-thrombotic agents’ particularly antiplatelet drugs expected to overtake anti-cholesterol drugs as the sales leader in the market. Maximum drugs were prescribed from the recent NLEM of India by most of practitioners its shows its acceptance and implementation by the prescribers.Conclusion: Deprescribing PPIs for the non-required patients is suggested to lower the risk of adverse drug interactions and economic burden to patients, also pharmacists needs to encourage the prescriptions with drugs in generic name if it’s deviated from the standards recommended by WHO/INRUD

Respuesta de los sujetos con hipertensión arterial a los fármacos antiagregantes plaquetarios / Response of hypertensive subjects to antiplatelet drugs

Introducción: La terapia con antiagregantes plaquetarios es recomendada como prevención secundaria de eventos cardiovasculares en personas con hipertensión arterial. Sin embargo, en la práctica clínica se encuentran personas que no responden al tratamiento y presentan recurrencia de eventos vasculares. Objetivo: Evaluar la respuesta de los sujetos hipertensos a los fármacos antiagregantes plaquetarios. Material y Métodos: Estudio transversal, observacional descriptivo y comparativo, con 299 sujetos con hipertensión arterial esencial y 96 no hipertensos (como control), que estaban consumiendo antiagregantes plaquetarios. Los sujetos hipertensos fueron agrupados de acuerdo con el consumo de fármacos antihipertensivos. Se les determinó su agregación plaquetaria al colágeno en plasma, rico en plaquetas, según el Método de Born. La respuesta a la terapia antiplaquetaria se clasificó en cuatro categorías (óptima, moderada, pobre y no respuesta) de acuerdo con la agregación plaquetaria. Resultados: Se observó una ligera mejor respuesta a los antiagregantes plaquetarios, aunque no estadísticamente significativa, por parte de los hipertensos sin fármacos antihipertensivos (35,7 por ciento óptima y 42,9 por ciento moderada), en relación con los hipertensos que usaban antihipertensivos (32,7 por ciento óptima y 26,5 por ciento moderada) y los no hipertensos (30,2 por ciento óptima y 30,2 por ciento moderada). Además, se encontró que 17,7 por ciento de los sujetos no hipertensos, 14,3 por ciento de los hipertensos sin fármacos antihipertensivos y 13,2 por ciento de los hipertensos con antihipertensivos no estaban respondiendo a los antiagregantes plaquetarios. Conclusiones: La respuesta a los fármacos antiagregantes plaquetarios de los sujetos hipertensos consuman o no fármacos antihipertensivos es heterogénea y similar a la de los sujetos no hipertensos(AU)

ABSTRACT Introduction: Therapy with antiplatelet drugs is recommended as secondary prevention of cardiovascular events in people with arterial hypertension. However, in the clinical practice, there are people who do not respond to treatment and evidence a recurrence of vascular events. Objective: To evaluate the response of hypertensive patients to antiplatelet drugs. Material and Methods: Cross-sectional, observational, descriptive and comparative study that included 299 subjects with arterial hypertension and 96 non-hypertensive subjects (control group) who were taking antiplatelet drugs. The hypertensive subjects were grouped according to the consumption of antihypertensive drugs. Platelet aggregation collagen in platelet-rich plasma was determined using the turbidimetric Born's method. The response to the antiplatelet therapy was classified in four categories (good, moderate, poor and non-responsiveness) in accordance with the platelet aggregation. Results: There was a slightly better response to antiplatelet drugs, although it was not statistically significant in hypertensive subjects without antihypertensive drugs (35,7 percent good and 42,9 percent moderate) in relation to hypertensive subjects who were taking antihypertensive drugs (32,7 percent good and 26,5 percent moderate) and the non-hypertensive ones (30,2 percent good and 30,2 percent moderate).Besides, it was found that 17,7 percent of non-hypertensive subjects and 14,3 percent of the hypertensive ones without antihypertensive drugs and 13,2 percent of hypertensive subjects with antihypertensive drugs were not responding to the treatment with antiplatelet drugs. Conclusions: The response of hypertensive patients to antiplatelet drugs, either taking antihypertensive drugs or not, is heterogeneous and similar to the response of the non-hypertensive subjects(AU)

Study on drug utilization pattern in cardiology outpatient department at tertiary care hospitals in South India: A prospective multicenter cross-sectional observational study

Background: Study of prescription patterns is an important to determine rationality of drug therapy and to maximize the utilization of resources. Objective: This prospective, multicenter, cross-sectional observational study was conducted at three selected tertiary care hospitals in South India to assess the drug utilization pattern (DUP) of cardiovascular drugs in outpatient department (OPD). Materials and Methods: A total of 1026 prescriptions of the patients attending cardiology OPD over a period of 1 year were randomly identified then critically analyzed for World Health Organization (WHO) core prescribing indicators. Results: The average number of drugs prescribed was five and medicines prescribed by its generic name were 2.33%, encounters with an injection prescribed (14.52%), medicines prescribed from National List of Essential Medicine (NLEM) were 89.27%, apart from above some other class of drugs also prescribed for patients with different comorbidities. Majority of drugs were prescribed as single drugs (86.78%) whereas 13.21% as fixed-dose combinations (FDCs). The most commonly prescribed single drug was aspirin (59.93%) and FDC were Aspirin + Clopidogrel (40.24%). Most of drugs were prescribed from the recent NLEM of India which indicates the implementation and adoption of national drug policy by the hospitals and cardiologists. Conclusion: Antiplatelets dominated the prescribing pattern in the cardiology OPD and expected to overtake anti-cholesterol agents as the sales leader. Updated knowledge about the banned drugs, irrational FDCs, deleted drugs, and recent NLEM are very important to both practitioners and pharmacists, also pharmacists have to encourage the prescribers to prescribe the cardiovascular drugs by its generic name.

Cost comparisons of five leading brands of the Antiplatelet drug, Clopidogrel, available in an Indian town

Background: Antiplatelet drugs need to be prescribed lifelong, for most of the selected patients, once started. Price disparity can lead to large financial stress on the patients, especially when cost related aspects are not paid heed to by the prescribing physician. This study was conducted to compare the cost, to the patient, of five most commonly prescribed preparations of different brands of Clopidogrel seventy five milligram, in Kolhapur city.Methods: The present study was undertaken during February 2019 to June 2019. Authors purchased a strip of 10 tablets each of the five leading brands of Clopidogrel seventy five milligram. The prices of the strip of 10 tablets of each of the five chosen brands were compared. Finally, the yearly cost of each of these five different preparations, was compared directly as well as using percentages. The data was collected, analyzed and presented in tabular forms and figures.Results: The data of the cost of five different brands of a single antiplatelet drug, Clopidogrel seventy five milligram shows that the annual cost of the costliest among the five brands of this drug is almost three times that of the cheapest brand, or in other words almost 300 percent that of the cheapest brand.Conclusions: The cost differences between the five brands were not negligible. India, with a major part of the population being very sensitive to the cost of medications, the prescribing physician must select the preparation wisely. The most costly preparation of Clopidogrel can significantly add to the the financial stress on the patient’s yearly expenditure. Thus, Pharmaco economic considerations must take a front seat while making a decision to prescribe medicines, especially in a country like India.

Economic Burden Evaluation of Adverse Events Caused by Antiplatelet Drugs in ACS Patients Using Markov-Monte Carlo Model / 中国药房

OBJECTIVE： To provide decision basis for antiplatelet therapy in ACS patients. METHODS： Markov model was established by collecting the related data in PLATO and TREAR study. Total bleeding risk， major bleeding risk， secondary bleeding risk and fatal bleeding risk in ACS patients who using ticagrelor or clopidogrel were calculated. Transfer probability， the cost and utility value between each state were collected and calculated according to previous literatures. The medical expenses of different methods were calculated by using TreeAge Pro 2011 software to obtain quality-adjusted life years （QALYs） and increment-cost- effectiveness ratio （ICER）. Furthermore， single-factor sensitivity analysis and probability sensitivity analysis were carried out. RESULTS： The average total cost of ticagrelor group was 66 449.38 yuan， obtaining 7.34 QALYs； the average total cost of clopidogrel group was 53 846.03 yuan， obtaining 6.68 QALYs. Compared with the clopidogrel group， the ICER of the ticagrelor group was 19 095.98 yuan/QALYs， that is， for each additional QALYs obtained， the cost of ticagrelor group was 19 095.98 yuan， less than willingness to pay threshold （64 644 yuan）. Sensitivity analysis was consistent with above analysis. CONCLUSIONS： Compared with clopidogrel， ticagrelor has less economic burden in ACS patients， especially in the patients with adverse bleeding events.

Obstructive Sleep Apnea Affecting Platelet Reactivity in Patients Undergoing Percutaneous Coronary Intervention / 中华医学杂志(英文版)

<p><b>Background</b>The relationship between obstructive sleep apnea (OSA) and platelet reactivity in patients undergoing percutaneous coronary intervention (PCI) has not been defined. The present prospective, single-center study explored the relationship between platelet reactivity and OSA in patients with PCI.</p><p><b>Methods</b>A total of 242 patients were finally included in the study. OSA was screened overnight by polysomnography. Platelet reactivity was assessed with a sequential platelet counting method, and the platelet maximum aggregation ratio (MAR) and average aggregation ratio were calculated. All patients were assigned per apnea-hypopnea index (AHI) to non-OSA (n = 128) and OSA (n = 114) groups. The receiver operating characteristic curve analysis was used to evaluate the accuracy of AHI for high platelet reactivity (HPR) on aspirin and clopidogrel, and multivariable logistic regression was used to determine the independent predictors of HPR on aspirin and clopidogrel.</p><p><b>Results</b>Median AHI was significantly higher in the OSA group than in the non-OSA group (34.5 events/h vs. 8.1 events/h, Z = -13.422, P < 0.001). Likewise, median arachidonic acid- and adenosine diphosphate-induced maximum aggregation rate (MAR) in the OSA group was significantly higher than those in the non-OSA group (21.1% vs. 17.7%, Z = -3.525, P < 0.001 and 45.8% vs. 32.2%, Z = -5.708, P < 0.001, respectively). Multivariable logistic regression showed that OSA was the only independent predictor for HPR on aspirin (odds ratio [OR]: 1.055, 95% confidence interval [CI]: 1.033-1.077, P < 0.001) and clopidogrel (OR: 1.036, 95% CI: 1.017-1.056, P < 0.001). The cutoff value of AHI for HPR on aspirin was 45.2 events/h (sensitivity 47.1% and specificity 91.3%), whereas cutoff value of AHI for HPR on clopidogrel was 21.3 events/h (sensitivity 68.3% and specificity 67.7%).</p><p><b>Conclusion</b>Platelet reactivity appeared to be higher in OSA patients with PCI despite having received a loading dose of aspirin and clopidogrel, and OSA might be an independent predictor of HPR on aspirin and clopidogrel.</p>

Causes Analysis of Acute Upper Gastrointestinal Bleeding in One Case of Postoperative Patients with PCI / 中国药师

Objective:To explore the role of clinical pharmacists in the use of antiplatelet drugs in the patients with PCI in periop-erative period in order to improve the clinical treatment effect and reduce the incidence of adverse drug reactions. Methods:According to the latest antiplatelet drug treatment guidelines and the related literatures, the causes of acute upper gastrointestinal bleeding induced by triple antiplatelet drugs were analyzed in one case of postoperative patients with PCI, and the rationality of the drug use and the treatment of bleeding were discussed, and the related suggestions were put forward for clinics. Results:In order to ensure the clinical safety and the rational use of drugs, the patients with high risk of bleeding and high thrombosis events should carefully select new anti-platelet drugs, and anti ischemic drugs with good efficacy and low bleeding risk were the first choices. Conclusion:In order to ensure medication safety and effectiveness, clinical pharmacists should actively participate in clinical rational drug use through giving relative suggestions and playing active roles in the rational use of antiplatelet drugs.

Research progress on role of platelets in development anddiagnosis of venous thrombosis / 中国药理学通报

Venous thromboembolism, which is a common thrombotic disease, is prone to become a fatal pulmonary embolism due to the lack of existing treatments.Although the anticoagulant drugs are widely used, the disease relapses easily.In recent years, there are much progress in the formation of venous thrombosis and diagnosis, and antiplatelet agents may play a certain role in the prevention of venous thrombosis.These new developments provide a new train of thought that platelets play as a breakthrough to find more effective treatments.This article summarizes the progress in the diagnosis of venous thrombosis on platelets in recent years, which discusses whether antiplatelet strategies could be applied in venous thrombosis so as to provide reference for further research.

ANTIPLATELET DRUGS INTERVENTION ON POSTOPERATIVE INCIDENCE OF NO -RE-FLOW IN PATIENTS WITH CORONARY HEART DISEASE / 现代医院

Objective To investigate the influence of antiplatelet drugs in patients with coronary heart dis-ease after intervention incidence of no -reflow.Methods 180 cases of coronary artery interventional treatment of coronary heart disease and patients with no -reflow phenomenon as research subjects were randomly divided into ob-servation group and the control group of 90 cases.Observation group after intervention produce given tirofiban hydro-chloride treatment of no -reflow or slow reflow, and the control group received verapamil therapy .Results The final group was injected with drugs Coronary angiography showed TIMI 3 cases number than the control group , and the difference was statistically significant ( p<0.05);After treatment of coronary angiography for the first time , the last observation group was significantly higher level TMPG3, and the difference was statistically significant (p<0.05). Conclusion Compared with verapamil hydrochloride tirofiban in patients with coronary heart disease , intervention can effectively reduce postoperative incidence of no -reflow, which should be spreaded in clinical practice .

Effect of dual antiplatelet drugs on Fibulin-5, vWF and P-selection in serum of patients with acute cerebral infarction / 中国生化药物杂志

Objective To analyse the effect of dual antiplatelet drugs on fibulin-5, vWF and P-selection in serum of patients with acute cerebral infarction.Methods Diagnosed 60 patients with acute cerebral infarction in our hospital and collected. All patients were randomly divided into experimental group and control group, 30 cases in each group.The control group was treated with conventional treatment and aspirin, and the experimental group was treated with clopidogrel on the basis of control group.After treatment, the serum levels of Fibulin-5, vWF, P-selection and adverse reactions were detected in all patients.ResuIts After treatment, compared with control group, the serum Fibulin-5 level was significantly lower in experimental group ( P<0.05 );the serum vWF level in experimental group was significantly lower ( P<0.05 );the serum P-selectin level in experimental group was significantly lower (P<0.05);there was no significant difference in the incidence of adverse reactions between two groups. ConcIusion Dual antiplatelet drugs can reduce serum vWF, P-selectin and fibulin-5 in serum of patients with acute cerebral infarction, adverse reactions do not significantly increase, have guiding significance to clinical application.

Effect of dual-antiplatelet drugs on S100β, IL-1β, adiponectin and NIHSS score in patients with acute cerebral infarction / 中国生化药物杂志

Objective To analyse the effect of dual-antiplatelet drugs on S100β,IL-1β, adiponectin(ADPN)and NIHSS score in patients with acute cerebral infarction.Methods 58 patients diagnosed with acute cerebral infarction in first hospital of Qinhuangdao.All patients were collected and randomly divided into experimental group and control group according to random number table , 29 cases in each group.Both group were given the treatrnent of improvng the cerebral vascular circulation, protect brain cells, control blood pressure, blood glucose, oxygen when necessary.On the basis of conventional treatment, control group was treated with aspirin 200 mg, one time per day,orally.And experimental group was treated with clopidogrel 75 mg/d on the basis of control group,one time per day,orally.After treatment, the serum levels of S100β, IL-1β, ADPN and NIHSS score were detected in all patients.ResuIts After treatment, compared with control group,the serum S100βprotein level was significantly lower in the experimental group (P<0.05); the serum IL-1βlevel in experimental group was significantly lower (P<0.05);ADPN level in experimental group was significantly higher (P<0.05); NIHSS score of patients in experimental group was significantly lower (P<0.05).ConcIusions Dual antiplatelet drugs can reduce serum S100βprotein,IL-1βin serum of patients with acute cerebral infarction, increase the level of serum adiponectin, decrease NIHSS score, can effectively improre neurological function in patients with acute cerebral infarction.

Monitoring of Antiplatelet Drugs by Thrombelastography / 中国药师

Antiplatelet drugs are widely used for various cardiovascular diseases. However, there is no standard for pharmaceutical care of antiplatelet drugs. In the paper, the development and application in antiplatelet drugs of thrombelastography were reviewed to analyze the application value of thrombelastography in effectiveness evaluation of antiplatelet drugs.

Pulmonary Alveolar Hemorrhage after Clopidogrel Use for ST Elevation Myocardial Infarction

Combination treatment of antiplatelet drugs containing aspirin and clopidogrel reduces systemic ischemic events after percutaneous coronary intervention (PCI) in high risk patients. However, this combination treatment of antiplatelet drugs is associated with increased risk of nonfatal and fatal bleeding. Diffuse alveolar hemorrhage after PCI is a rare complication that has been mostly reported in association with glycoprotein IIb/IIIa inhibitors. We report the case of a 62-year-old man who presented with ST elevation myocardial infarction and suffered a diffuse alveolar hemorrhage after clopidogrel use following primary PCI.