Prótesis SAPIEN XT sobre SAPIEN XT estenótica / SAPIEN XT Valve-in-valve implantation in stenotic valve

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VERifyNow in DIabetes high-on-treatment platelet reactivity: a pharmacodynamic study on switching from clopidogrel to prasugrel.

INTRODUCTION: Diabetic patients with an acute coronary syndrome undergoing percutaneous coronary intervention frequently exhibit high platelet reactivity while on clopidogrel. We hypothesized that in diabetic patients undergoing percutaneous coronary intervention, who exhibit high-platelet-reactivity after standard treatment with clopidogrel, a 60-mg prasugrel loading dose is superior to standard treatment with clopidogrel for optimal P2Y12 inhibition within the first 24-36 h post-angioplasty. METHODS: VERDI was a prospective, randomized, single-centre, single-blind, parallel-design study (NCT01684813). Consecutive diabetic patients with an non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention and loaded with clopidogrel were considered for platelet reactivity assessment immediately before angioplasty with the VerifyNow assay measured in P2Y12 reaction units (PRU). Fifty of 63 screened patients (79.4%) had high platelet reactivity (PRU ≥ 208) and were randomized to receive a 60-mg prasugrel loading dose (n = 25) versus clopidogrel standard dose (n = 25). Platelet function was assessed again 24 hours post-angioplasty. RESULTS: Prasugrel achieved greater platelet inhibition than clopidogrel 24 hours post-angioplasty (median [interquartile range], 38 [9-72] vs 285 [240-337], respectively; P < 0.001). The non-high-platelet-reactivity rate (PRU < 208) at 24 h post-angioplasty (primary end point) was higher with prasugrel; 25 patients (100%) in the prasugrel group achieved optimal antiaggregation vs 4 patients (16%) in the clopidogrel group (P < 0.001). No significant acute bleeding was documented in either group. CONCLUSION: Among type 2 diabetic patients suffering an acute coronary syndrome with high-platelet-reactivity undergoing percutaneous coronary intervention, switching from clopidogrel to prasugrel was superior to standard treatment with clopidogrel for the achievement of optimal antiaggregation within the first 24 hours post-angioplasty.

Assessment methods for aspirin-mediated platelet antiaggregation in type 2 diabetic patients: degree of correlation between 2 point-of-care methods.

AIMS: Impaired response to antiplatelet therapy in diabetic patients results in a higher incidence of drug-eluting stent thrombosis. This study determined the prevalence of high on-aspirin (AS) platelet reactivity in type 2 diabetic patients treated with percutaneous coronary intervention (PCI) using the VerifyNow Aspirin Assay (VN) and platelet function analyzer PFA-100 (PFA-100) and analyzed the correlation between both methods. METHODS: Type 2 diabetic patients (100) with non-ST-elevation acute coronary syndrome who underwent PCI and Xience V drug-eluting stent implantation were included in this study. After PCI, platelet antiaggregation mediated by acetylsalicylic acid was assessed by VN and PFA-100. The degree of correlation and concordance was then determined. RESULTS: When assayed with VN, 7% of the patients were nonresponders to aspirin (aspirin reaction units >550), and when assayed with PFA-10, 41% were nonresponders (closure time <193 seconds). Of the patients, 4% were nonresponders to aspirin according to VN but were sensitive to aspirin according to PFA-100, and 38% were sensitive to aspirin according to VN and nonresponders according to PFA-100. Overall, 55% of the patients were aspirin-sensitive in both methods. The Spearman's coefficient between VN and PFA-100 results was r = 0.09 (P = 0.35). The kappa index value was 0.0062 (P = 0.91). CONCLUSIONS: There is no concordance or correlation between the VN and PFA-100 results. Therefore, the use of these analyses should be restricted to clinical research, which limits its application in clinical practice.

A comparative study of bivalirudin plus clopidogrel versus bivalirudin plus prasugrel in primary angioplasty using propensity score matching.

INTRODUCTION AND OBJECTIVES: In primary angioplasty, bivalirudin is superior to treatment with heparin plus glycoprotein inhibitors for reducing cardiovascular events, although bivalirudin increases the risk of stent thrombosis. Our hypothesis is that the use of prasugrel plus bivalirudin in primary angioplasty would reduce stent thrombosis and cardiovascular events. METHOD: Consecutive patients with acute ST-segment elevation myocardial infarction who were treated by primary angioplasty within 12 hours of the onset of symptoms received bivalirudin plus clopidogrel (Group A) or bivalirudin plus prasugrel (Group B). We compared the groups using propensity score matching. The combined end-point was cardiac death, thrombosis, acute myocardial infarction, and cerebrovascular accident at 30 days. RESULTS: We assessed 168 patients. The approach was preferentially radial (95.7%). No differences in baseline characteristics were observed between Groups A (n = 70) and B (n = 70). The total mortality and rate of major bleeding complications at 30 days were 0% for both of the groups. The rate of acute and subacute thrombosis was 4.3% in Group A and 0% in Group B (P = 0.08). We observed an increased rate of events in Group A (5.7%) versus Group B (0%) (P = 0.042). CONCLUSIONS: The administration of bivalirudin plus prasugrel in primary percutaneous coronary intervention reduces cardiovascular effects compared to bivalirudin plus clopidogrel without increasing major bleeding complications during the first 30 days following primary angioplasty performed with a preferentially radial approach.