Analysis of prescribing of antiplatelet drug in patients with coronary heart disease in department of geriatrics / 中国临床药理学与治疗学

AlM: To analyze the prescribing of different antiplatelet drugs and clinical conditions of patients with coronary heart disease in department of Geriatrics. METHODS: This study was a single center and cross-sectional study. Patients with coronary heart disease were recruited when hospitalized in the department of Geriatrics department, Xiangya Hospital, Central South University between December 2021 and June 2022. We investigated and analyzed the clinical conditions of patients including the prescribing of the antiplatelet drugs. RESULTS: A total of 347 coronary heart disease patients with a mean age of (65.2 ± 10.1) years were included. The antiplatelet drug clopidogrel was the most commonly prescribed. Among the different dual antiplatelet therapy (DAPT), aspirin combined with clopidogrel was the most widely used. With the increasing of the numbers of target coronary lesions, the prescribing rate of clopidogrel increased significantly (P < 0.05). In three groups with different degrees of target coronary lesions, the prescribing rate of aspirin was higher than that of indobufene (P < 0.05). Compared with patients taking aspirin, the patients taking indobufene were older with a higher blood creatinine level, a higher proportion of chronic gastropathy and the higher level of platelet aggregation rates (P < 0.05). CONCLUSlON: Clopidogrel is the most commonly prescribed antiplatelet drugs in patients with coronary heart disease. Aspirin combined with clopidogrel is the most widely used in DAPT. Compared with aspirin, indobufene is more commonly used in elderly patients with the chronic gastritis and a higher serum creatinine level.

Safety of anticoagulants and antiplatelet drugs in patients with recurrent spontaneous abortion during pregnancy / 上海交通大学学报（医学版）

Recurrent spontaneous abortion (RSA) is defined as the loss of at least two consecutive pregnancies before the 28th week of gestation. RSA is a complicated pathological condition caused by multiple factors including genetic abnormalities, anatomical factors, endocrine disorders, immune abnormalities, prethrombotic state (PTS) and infection factors. Studies have suggested that anticoagulation and antiplatelet therapy could significantly improve the pregnancy outcomes of RSA patients with PTS and autoimmune abnormalities. Frequently used anticoagulants and antiplatelet drugs are heparin, heparinoid, warfarin, aspirin and clopidogrel. However, the maternal and fetal safety after the use of these drugs during pregnancy has long been concerned. Safety of anticoagulants and antiplatelet drugs in patients with recurrent spontaneous abortion during pregnancy is reviewed.

Establishment of Platelet Membrane Chromatography and Column Temperature Study / 中国药学杂志

OBJECTIVE: To establish a platelet cell membrane chromatographic model and investigate the retention behaviors of anti-platelet aggregation drugs on chromatographic column at different temperatures, and simulate the interactions between drugs and platelets under normal and febrile pathological conditions. METHODS: The platelet cell membrane chromatographic stationary phase was constructed by physical adsorption method. The column was packed with wet method. The protein content was determined by BCA protein concentration assay kit. The biological activity was determined by Na+, K+-ATPase assay kit. The chromatographic model was used to investigate the specificity of the column and the retention characteristics of drugs in the temperature range of 35.0-42.0℃. RESULTS: The activity of platelet ATPase was 0.214, and the concentration of platelet membrane protein was 0.340 9 mg•mL-1 before bonding and 0.080 5 mg•mL-1 after bonding. The retention characteristics of clopidogrel, dipyridamole and cilostazole on platelet cell membrane chromatographic column and blank silica gel column were quite different. The retention time of the three drugs on platelet cell membrane chromatographic column was the maximum at 36.0℃, and then decreased with the increase of temperature. CONCLUSION: A platelet cell membrane chromatographic model is successfully constructed, and the retention characteristics of antiplatelet aggregates at different temperatures are studied for the first time. The chromatographic retention behaviors of antiplatelet aggregates at normal and febrile body temperatures are simulated.

Efficacy and safety of dual antiplatelet prolongation therapy after PCI in ACS patients guided by dapt scoring system / 解放军医学杂志

Objective To investigate the efficacy and safety of extended treatment for one year with different doses of clopidogrel plus aspirin after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) based on dual antiplatelet therapy (DAPT) scoring system. Methods From April 2016 to December 2016, 225 patients with ACS, one year after successfully undergoing PCI and with ≥2 of DAPT score were enrolled in present study, and randomly divided into 3 groups (75 each): control group, observation group A and observation group B. Patients in control group were given aspirin enteric tablet 100mg qd, in observation group A were given aspirin 100mg qd plus clopidogrel 75mg qd, and in observation group B were given aspirin 100mg qd plus clopidogrel 50mg qd. All patients were followed up for one year, the incidence of cardio-and cerebrovascular events and bleeding events were observed and compared among the 3 groups. At the same time, the ADP-induced platelet aggregation rate and the platelet function (MA) from thromboelastography (TEG) pre-and post-treatment were analyzed. Results During the 12-month observation period, the overall incidence of cardiovascular events showed statistical differences among control group, observation groups A and B (21.3% vs. 5.3% vs. 5.3%, P0.05). In control group, observation groups A and B, the incidences of mild bleeding (BARC1+2) (2.6% vs. 12.0% vs. 3.9%) and total bleeding events (2.6% vs. 13.3% vs. 3.9%) showed statistical differences (P0.05). The platelet aggregation rate and platelet function (MA) in observation groups A and B decreased significantly than that in control group one year after prolonged antiplatelet therapy (P<0.05). Conclusions Assessment of ischemia risk with DAPT scoring system in patients with ACS, prolonged clopidogrel plus aspirin therapy for those patients with DAPT score ≥2 could reduce the incidence of major cardiovascular events, and low dose clopidogrel dose not increase the risk of bleeding complications.

The Influence of Antiplatelet Drug Medication on Spine Surgery

BACKGROUND: The incidence of cardiovascular and neurovascular diseases has been increasing with the aging of the population, and antiplatelet drugs (APDs) are more frequently used than in the past. With the average age of spinal surgery patients also increasing, there has been a great concern on the adverse effects of APD on spine surgery. To our knowledge, though there have been many studies on this issue, their results are conflicting. In this study, we aimed to determine the influence of APDs on spine surgery in terms of intraoperative bleeding and postoperative spinal epidural hematoma complication. METHODS: Patients who underwent posterior thoracolumbar decompression and instrumentation at our institution were reviewed. There were 34 APD takers (APDT group). Seventy-nine non-APD takers (NAPDT group) were selected as a control group in consideration of demographic and surgical factors. There were two primary endpoints of this study: the amount of bleeding per 10 minutes and cauda equina compression by epidural hematoma measured at the cross-sectional area of the thecal sac in the maximal compression site on the axial T2 magnetic resonance imaging scans taken on day 7. RESULTS: Both groups were homogeneous regarding age and sex (demographic factors), the number of fused segments, operation time, and primary/revision operation (surgical factors), and the number of platelets, prothrombin time, and activated partial thromboplastin time (coagulation-related factors). However, the platelet function analysis-epinephrine was delayed in the APDT group than in the NAPDT group (203.6 seconds vs. 170.0 seconds, p = 0.050). Intraoperative bleeding per 10 minutes was 40.6 ± 12.8 mL in the APDT group and 43.9 ± 9.9 mL in the NAPDT group, showing no significant difference between the two groups (p = 0.154). The cross-sectional area of the thecal sac at the maximal compression site by epidural hematoma was 120.2 ± 48.2 mm2 in the APDT group and 123.2 ± 50.4 mm2 in the NAPDT group, showing no significant difference between the two groups (p = 0.766). CONCLUSIONS: APD medication did not increase intraoperative bleeding and postoperative spinal epidural hematoma. Therefore, it would be safer to perform spinal surgery without discontinuation of APD therapy in patients who are vulnerable to cardiovascular and neurovascular complications.

Long-term Treatment with Anti-platelet Agents for Collagen-induced Arthritis Improves Radiological Findings

OBJECTIVES: The objectives of this study were to evaluate the long-term effect of anti-platelet treatment on the radiological progression of collagen-induced arthritis in rats. METHODS: Female Lewis rats with collagen-induced arthritis were divided into three experimental groups: saline, aspirin monotherapy (n = 12), and aspirin–clopidogrel dual therapy (n = 12). Drugs were administered daily and continued up to 70 days after the induction of arthritis. The clinical arthritis index (weight, morphology score, and paw thickness) and radiological scores were evaluated. RESULTS: The clinical arthritis index peaked on day 20, while the radiological scores peaked on day 35. No intergroup difference was observed in the clinical arthritis index throughout the experiment. The aspirin–clopidogrel dual therapy group had a significantly higher mean radiological score than the other groups (p = 0.045) on day 35. Further treatments resulted in significantly improved radiological findings in the aspirin monotherapy and aspirin–clopidogrel dual therapy groups on day 70 but no significant improvement in the saline group. CONCLUSION: Anti-platelet agent treatment improved radiological findings on day 70. These observations emphasize the importance of a future long-term study of the effects of anti-platelet agent treatment on arthritis.

Procedimientos endoscópicos y terapias antitrombóticas. Una visión actual / The Current View of Endoscopic procedures and Antithrombotic Therapies

Resumen En los últimos años se ha generado un avance importante en el tratamiento de las patologías procoagulantes con antiguos y nuevos medicamentos y se ha logrado un importante avance en los métodos diagnósticos y terapéuticos en la endoscopia digestiva. Además, la expectativa de vida de la población mundial se ha incrementado de forma considerable, por lo que más frecuentemente el gastroenterólogo debe realizar procedimientos endoscópicos en pacientes de mayor edad, quienes presentan comorbilidades por las que reciben terapias antitrombóticas, especialmente por patologías cardiovasculares. En la literatura aparecen muchas guías de manejo avaladas por importantes asociaciones, en las que se orienta sobre la realización de procedimientos endoscópicos en los pacientes sometidos a terapias antitrombóticas, procedimientos que representan un determinado riesgo de sangrado o trombosis en caso de la suspensión de los medicamentos, pero no se han realizado estudios prospectivos o controlados que permitan formular protocolos para las diversas técnicas endoscópicas diagnósticas o terapéuticas en estos pacientes. El gastroenterólogo debe realizar un balance entre el riesgo hemorrágico y embólico para determinar cuál es el momento más indicado para realizar un procedimiento endoscópico en estos pacientes; por lo tanto, es de gran importancia que tenga conocimiento de este tema. Se presenta una revisión actualizada de la literatura y las más recientes recomendaciones de la sociedad europea de gastroenterología.

Abstract In recent years, treatment of pathologies related to hypercoagulation has advanced significantly as the result of the use of old and new drugs. In addition, significant advances have been achieved in diagnostic and therapeutic methods in digestive endoscopy. On the other hand, the life expectancy of the world population has increased considerably, so gastroenterologists must perform endoscopic procedures more frequently in older patients who present comorbidities for which they receive antithrombotic therapies, especially for cardiovascular diseases. Many treatment guides produced by important medical associations are available. They are oriented to the performance of endoscopic procedures in patients undergoing antithrombotic therapies. These patients are at risk of bleeding during or after these procedures, and they are at risk of thrombosis when medication is suspended. Nevertheless, no prospective or controlled studies have been performed to guide formulation of protocols for the various diagnostic and therapeutic endoscopic techniques that might be used for these patients. Gastroenterologists must balance the risks of bleeding and embolism to determine the most appropriate time to perform an endoscopic procedure in these patients. Therefore, it is of great importance that you have knowledge of this topic. We present an updated review of the literature and the most recent recommendations of the European society of gastroenterology.

Stroke, platelet activating factor and receptor antagonists / 中国中药杂志

Stroke is an acute cerebrovascular disease with high morbidity, disability and mortality. The prevention and treatment conditions for stroke is severe all over the world. Antiplatelet aggregation is an effective treatment. Platelet activation factor (PAF) is another important medium in mediating platelet aggregation, which plays an important role in the pathogenesis of stroke. In recent years, PAF receptor antagonists have attracted international attention in the field of stroke prevention and treatment. In this review, we would summarize the classification, mechanism and drug characteristics of PAF receptor antagonists in order to provide the valuable guidance and direction for clinical medicine and research.

Monitoring of antiplatelet therapy and changes of mean platelet volume after percutaneous coronary intervention in the patients with coronary heart disease / 临床检验杂志

Objective To compare the consistency of thrombelastography (TEG) and light transmittance aggregometry (LTA) in monitoring the antiplatelet therapy of the patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI),and observe the changes of mean platelet volume (MPV) of the patients treated with aspirin and clopidogrel after PCI.Methods A total of 177 patients undergoing PCI and the treatment of aspirin and clopidogrel in Peking University First Hospital during March 2014 and May 2015 were enrolled in the study.Their adenosine diphosphate (ADP) or arachidonic acid (AA) induced platelet inhibition rates determined by TEG,MPV before and after antiplatelet therapy,and the maximum platelet aggregation rates measured by LTA from 99 patients were retrospectively analyzed.Results There was no any correlation between the maximum aggregation rates measured by LTA and the platelet inhibition rates determined by TEG regardless of using ADP or AA as agonist (all P ＞ 0.05).The detection rates of clopidogrel hyporesponsiveness determined by LTA and TEG were 30.3％ and 45.5％,respectively,while those of aspirin hyporesponsiveness were 19.2％ and 31.3％,respectively.The detection rate of hyporesponsiveness determined by LTA was significant lower than that by TEG (P ＜ 0.05).The MPVs after antiplatelet therapy were significant lower than that before treatment (all P ＜ 0.01) regardless of clopidogrel hyporesponsive or sensitive and aspirin hyporesponsive or sensitive.The MPVs in clopidogrel hyporesponsive group before and after treatment were significantly lower than that in clopidogrel sensitive group (all P ＜ 0.05).The PLT counts in clopidogrel or aspirin hyporesponsive groups after treatment were significantly higher than that before treatment (all P ＜ 0.05).Conclusion There is poor correlation between LTA and TEG.It should be noted that the incidence rate of antiplatelet drug hyporesponsiveness is high in clinical practice.The MPVs of the patients significantly decrease after antiplatelet therapy.The patients with a significant increase of PLT after antiplatelet therapy are more likely to become drug hyporesponsiveness,while the patients with lower MPV are more likely to have clopidogrel hyporesponsiveness.

Evaluation and Treatment of the Acute Cerebral Infarction with Convexal Subarachnoid Hemorrhage

Non-traumatic convexal subarachnoid hemorrhage (CSAH) is a comparatively infrequent with various vascular and nonvascular causes, it rarely occurs concomitant to acute ischemic stroke. We report a case of a 59-year-old woman, visited emergency room with right side subjective weakness spontaneously. Magnetic resonance diffusion-weighted images revealed an acute infarction of anterior cerebral arterial territory. Computed tomographic angiography showed a left frontal CSAH without any vascular lesions. And other laboratory studies were non-specific. We treated with dual antiplatelet drugs (cilostazole [Otsuka Pharmaceutical Co., Ltd. tokyo, Japan] and Aspirin [Bayer Pharma AG., Leverkusen, Germany]). She has done well for a follow-up period. (5 months) This case demonstrates the CSAH with acute infarction is rare but need to work up to identify the etiology and antiplatelet dugs are taken into account for treatments.

The research of double antiplatelet drug combined with pantoprazole in the treatment of ischemic stroke / 中国基层医药

Objective To research whether double antiplatelet drug combined with pantoprazole can reduce digestive tract damage,or aggravate cardiovascular system side effect.Methods 270 patients diagnosed as ischemic stroke received double antiplatelet drug were randomly divided into two groups.The treatment group received panto-prazole,the control group did not took any gastric drug.The side effect of the digestive and cardiovascular system was observed.Results 268 patients were followed up for 90 days,and digestive system side effect of the treatment group (136 cases)included indigestion in 26 cases(19.11%),stool occult blood(+)in 11 cases(8.08%),melena in 8 cases(5.89%),hematemesis in 0 case,and the control group (132 cases)included indigestion in 42 cases (31.82%),stool occult blood(+)in 23 cases(17.42%),melena in 19 cases(14.39%),hematemesis in 4 cases. There were significant differences between the two groups(χ2 =6.66,4.56,11.2 and 4.18,all P 0.05 ).Conclusion Double antiplatelet drug combined with pantoprazole had a positive significance in reducing the digestive tract damage of ischemic stroke patients,and didn't increase the incidence of cardiovascular sys-tem side effect.

Incidence of pocket hematoma after electrophysiological device placement：dual antiplatelet therapy versus low-molecular-weight heparin regimen / 老年心脏病学杂志（英文版）

Background Given the increasing number of patients who require dual antiplatelet (DAP) therapy and electrophysiological device (EPD) placement, perioperative antiplatelet management is a current challenge. In this study, we investigated the incidence of pocket hema-toma formation after EPD placement in patients undergoing DAP therapy or an alternative low-molecular-weight heparin (LMWH) regimen. Methods This clinical observational study was performed from July 2010 to July 2012. In total, 171 patients were enrolled in the analysis after meeting the inclusion criteria. These patients were divided into two groups: 86 patients were treated with DAP therapy at the time of device implantation, and the DAP therapy was discontinued for 5 to 7 days and replaced with enoxaparin before device implantation in the other 85 patients. Adenosine phosphate (ADP)-mediated platelet aggregation and arachidonic acid-induced platelet aggregation were tested preoperatively. We compared the incidence of pocket hematoma between the two groups and the association of pocket hematoma develop-ment with ADP-mediated platelet aggregation and arachidonic acid-induced platelet aggregation.Results The incidence of pocket hema-toma in the patients who continued DAP was lower than that in the patients who replaced the dual antiplatelet regimen with LMWH (3.49%vs. 16.47%, respectively;X2 = 6.66,P < 0.01). Among the patients who continued DAP therapies, the rate of ADP-mediated platelet aggre-gation inhibition in patients with pocket hematomas was higher than that in patients without pocket hematomas. None of the patients under-going DAP or enoxaparin therapy developed pocket infection, thromboembolic events, or other serious complications. Multiple logistic re-gression analysis revealed that LMWH therapy was an independent risk factor for the development of pocket hematoma (RR = 0.054, 95%CI = 0.012-0.251). Furthermore, patients undergoing LMWH therapy were 5.1-fold more likely to develop pocket hematomas than were DAP-treated individuals.Conclusion Continuance of DAP therapy does not increase the risk of pocket hematoma formation after EPD placement.

Pharmacological Functional Magnetic Resonance Imaging of Cloropidol on Motor Task

PURPOSE: To investigate the pharmacologic modulation of motor task-dependent physiologic responses by antiplatelet agent, clopidogrel, during hand motor tasks in healthy subjects. MATERIALS AND METHODS: Ten healthy, right-handed subjects underwent three functional magnetic resonance (fMRI) sessions: one before drug administration, one after high dose drug administration and one after reaching drug steady state. For the motor task fMRI, finger flexion-extension movements were performed. Blood oxygenation level dependent (BOLD) contrast was collected for each subject using a 3.0 T VHi (GE Healthcare, Milwaukee, USA) scanner. T2*-weighted echo planar imaging was used for fMRI acquisition. The fMRI data processing and statistical analyses were carried out using SPM2. RESULTS: Second-level analysis revealed significant increases in the extent of activation in the contralateral motor cortex including primary motor area (M1) after drug administration. The number of activated voxels in motor cortex was 173 without drug administration and the number increased to 1049 for high dose condition and 673 for steady-state condition respectively. However, there was no significant difference in the magnitude of BOLD signal change in terms of peak T value. CONCLUSION: The current results suggest that cerebral motor activity can be modulated by clopidogrel in healthy subjects and that fMRI is highly senstive to evidence such changes.

Pharmaceutical Care in the Therapy of Anticoagulant and Antiplatelet Drug / 中国药房

OBJECTIVE: To summarize the advantage and pharmaceutical care of antiplatelet drug because antiplatelet drug has satisfactory effect on thrombotic disease and platelet disorder with rapid development and sound clinical utilization and evaluation. METHODS: Literature review method was adopted to analyze medical literatures at home and abroad. RESULTS&CONCLUSION: In the large number of clinical studies, anticoagulant and antiplatelet drug have sound efficacy. Therefore it is important to use anticoagulant and antiplatelet drug rationally and safely.

EFFECTS OF BERBERINE ON PLATELET AGGREGATION AND RELEASE / 第二军医大学学报

We have discovered that bcrberine (BR) is an anti-platelet drug.It was demonstrated that BR inhibited ADP-, arachidonate-, collagen-and calcium ionophorc A231S7-xnduced platelet aggregation and ATP release in different degrees.Especially BR strongly inhibited collagen-induced platelet aggregation and ATP release reaction(IC50 values were 0.12 and 0.08 mmol/L,respectively).The antiplatekt mechanism of BR may be inhibition of arachidonate metabolism,, and suppression of the rise of intracdlular Ca2' and/or cAMP levels.Because the platelet thrombus foimation in the arteries of brain and heart is closely related to the subendothelial collagen fibrils, BR may be an effective drug for the patients with these diseases.