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[PMID]:29442035
[Au] Autor:Incecayir T; Ilbasmis-Tamer S; Tirnaksiz F; Degim T
[Ti] Título:Assessment of the potential drug-drug interaction between carvedilol and clopidogrel mediated through intestinal P-glycoprotein.
[So] Source:Pharmazie;71(8):472-477, 2016 08 01.
[Is] ISSN:0031-7144
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:The most widely prescribed oral antiplatelet agent, clopidogrel, shows high interindividual variability resulting in an increased risk of cardiovascular events in the patients with reduced platelet inhibition. The purpose of this study was to investigate the role of the P-glycoprotein (P-gp) efflux pump in limiting the intestinal permeability of clopidogrel and the effect of a ß-blocker, namely, carvedilol, on its intestinal transport. Effective permeabilities (Peff) of clopidogrel and carvedilol were investigated in the proximal jejunum and distal ileum of rats using an in situ intestinal perfusion model. Peff values of clopidogrel and carvedilol were found to be concentration dependent with decreased Peff values at the low perfusate concentrations. Coperfusion with the P-gp inhibitors verapamil (100 µM) and carvedilol (10 µM) significantly increased the Peff of clopidogrel in the jejunum (8.31±0.20 x 10-5 and 6.98±0.75 x 10-5 vs. 3.60±0.51 x 10-5, respectively) and ileum (9.08±2.19 x 10-5 and 8.35±1.58 x 10-5 vs. 3.85±0.15 x 10-5, respectively). However, at the highest concentration tested (30 µM), clopidogrel exhibited 3 and 1.4 times higher Peff than those of metoprolol, an FDA high permeability reference standard, in the jejunum and ileum, respectively. Overall, this study indicates that the efflux function appears not to have a significant impact on the in vivo intestinal absorption of clopidogrel due to the saturation of P-gp, suggesting no clinically relevant interaction between carvedilol and clopidogrel mediated through P-gp at intestinal level.
[Mh] Termos MeSH primário: Membro 1 da Subfamília B de Cassetes de Ligação de ATP/efeitos dos fármacos
Antagonistas Adrenérgicos beta/farmacologia
Carbazóis/farmacologia
Intestino Delgado/efeitos dos fármacos
Inibidores da Agregação de Plaquetas/farmacologia
Propanolaminas/farmacologia
Ticlopidina/análogos & derivados
[Mh] Termos MeSH secundário: Membro 1 da Subfamília B de Cassetes de Ligação de ATP/antagonistas & inibidores
Animais
Interações Medicamentosas
Absorção Intestinal/efeitos dos fármacos
Intestino Delgado/metabolismo
Masculino
Metoprolol/farmacologia
Perfusão
Permeabilidade/efeitos dos fármacos
Ratos
Ratos Wistar
Ticlopidina/farmacologia
Verapamil/farmacologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (ATP-Binding Cassette, Sub-Family B, Member 1); 0 (Adrenergic beta-Antagonists); 0 (Carbazoles); 0 (Platelet Aggregation Inhibitors); 0 (Propanolamines); 0K47UL67F2 (carvedilol); A74586SNO7 (clopidogrel); CJ0O37KU29 (Verapamil); GEB06NHM23 (Metoprolol); OM90ZUW7M1 (Ticlopidine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1691/ph.2016.6059


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[PMID]:28465300
[Au] Autor:Pelletier-Galarneau M; Hunter CRRN; Ascah KJ; Beanlands RSB; Dwivedi G; deKemp RA; Chow BJW; Ruddy TD
[Ad] Endereço:Division of Nuclear Medicine, The Ottawa Hospital, Ottawa, Canada.
[Ti] Título:Randomized Trial Comparing the Effects of Ticagrelor Versus Clopidogrel on Myocardial Perfusion in Patients With Coronary Artery Disease.
[So] Source:J Am Heart Assoc;6(5), 2017 May 02.
[Is] ISSN:2047-9980
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Ticagrelor is a P2Y receptor inhibitor used in acute coronary syndromes to reduce platelet activity and to decrease thrombus formation. Ticagrelor is associated with a reduction in mortality incremental to that observed with clopidogrel, potentially related to its non-antiplatelet effects. Evidence from animal models indicates that ticagrelor potentiates adenosine-induced myocardial blood flow (MBF) increases. We investigated MBF at rest and during adenosine-induced hyperemia in patients with stable coronary artery disease treated with ticagrelor versus clopidogrel. METHODS AND RESULTS: This randomized double-blinded crossover study included 22 patients who received therapeutic interventions of ticagrelor 90 mg orally twice a day for 10 days and clopidogrel 75 mg orally once a day for 10 days, with a washout period of at least 10 days between the treatments. Global and regional MBF and myocardial flow reserve were measured using rubidium 82 positron emission tomography/computed tomography at baseline and during intermediate- and high-dose adenosine. Global MBF was significantly greater with ticagrelor versus clopidogrel (1.28±0.55 versus 1.13±0.47 mL/min per gram, =0.002) at intermediate-dose adenosine and not different at baseline (0.65±0.19 versus 0.60±0.15 mL/min per gram, =0.084) and at high-dose adenosine (1.64±0.40 versus 1.61±0.19 mL/min per gram, =0.53). In regions with impaired myocardial flow reserve (<2.5), MBF was greater with ticagrelor compared with clopidogrel during intermediate and high doses of adenosine ( <0.0001), whereas the differences were not significant at baseline. CONCLUSIONS: Ticagrelor potentiates global and regional adenosine-induced MBF increases in patients with stable coronary artery disease. This effect may contribute to the incremental mortality benefit compared with clopidogrel. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01894789.
[Mh] Termos MeSH primário: Adenosina/análogos & derivados
Doença da Artéria Coronariana/tratamento farmacológico
Circulação Coronária/efeitos dos fármacos
Vasos Coronários/efeitos dos fármacos
Inibidores da Agregação de Plaquetas/administração & dosagem
Ticlopidina/análogos & derivados
[Mh] Termos MeSH secundário: Adenosina/administração & dosagem
Adenosina/efeitos adversos
Administração Oral
Idoso
Doença da Artéria Coronariana/diagnóstico por imagem
Doença da Artéria Coronariana/fisiopatologia
Vasos Coronários/diagnóstico por imagem
Vasos Coronários/fisiopatologia
Estudos Cross-Over
Método Duplo-Cego
Esquema de Medicação
Feminino
Seres Humanos
Masculino
Meia-Idade
Imagem de Perfusão do Miocárdio/métodos
Ontário
Inibidores da Agregação de Plaquetas/efeitos adversos
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
Valor Preditivo dos Testes
Compostos Radiofarmacêuticos/administração & dosagem
Radioisótopos de Rubídio/administração & dosagem
Ticlopidina/administração & dosagem
Ticlopidina/efeitos adversos
Fatores de Tempo
Resultado do Tratamento
Vasodilatadores/administração & dosagem
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE II; COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Platelet Aggregation Inhibitors); 0 (Radiopharmaceuticals); 0 (Rubidium Radioisotopes); 0 (Vasodilator Agents); A74586SNO7 (clopidogrel); GLH0314RVC (Ticagrelor); K72T3FS567 (Adenosine); OM90ZUW7M1 (Ticlopidine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE


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[PMID]:29381951
[Au] Autor:Wong CK; Chan PH; Lam CC; Kwok OH; Lam YY; Siu CW
[Ad] Endereço:Cardiology Division, Department of Medicine, The University of Hong Kong.
[Ti] Título:WATCHMAN device-related thrombus successfully treated with apixaban: A case report.
[So] Source:Medicine (Baltimore);96(47):e8693, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Among atrial fibrillation patients with high risk of bleeding, left atrial appendage occlusion has emerged as an alternative to long-term oral anticoagulation therapy for stroke prevention. Device-related thrombus remains a major concern because it may result in recurrent embolic events. To date, there is no consensus on the optimal method of treating device-related-thrombus. PATIENT CONCERNS: A 78-year-old man with atrial fibrillation had an episode of intracranial hemorrhage while taking warfarin. He subsequently underwent percutaneous placement of a 30-mm Watchman device to the left atrial appendage. He was prescribed dual anti-platelet therapy with aspirin and clopidogrel. DIAGNOSIS: Reassessment echocardiography 3 months later found device-related thrombus. INTERVENTIONS: The antithrombotic regimen was switched from dual antiplatelet therapy to apixaban. OUTCOMES: Reassessment echocardiography 3 months later revealed complete resolution of the device-related thrombus. Apixaban was stopped. He had dual antiplatelet therapy for 6 more months followed by life-long aspirin. There was no bleeding complication since implantation of Watchman device. LESSONS: We demonstrated successful treatment of device-related thrombus with a short course of apixaban with complete resolution of thrombus. Further randomized controlled trials are required to determine the choice and duration of drug therapy for device-related thrombus.
[Mh] Termos MeSH primário: Fibrilação Atrial/cirurgia
Inibidores do Fator Xa/uso terapêutico
Próteses e Implantes/efeitos adversos
Pirazóis/uso terapêutico
Piridonas/uso terapêutico
Trombose/tratamento farmacológico
Trombose/etiologia
[Mh] Termos MeSH secundário: Idoso
Anticoagulantes/administração & dosagem
Aspirina/administração & dosagem
Apêndice Atrial/cirurgia
Seres Humanos
Masculino
Trombose/prevenção & controle
Ticlopidina/administração & dosagem
Ticlopidina/análogos & derivados
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Factor Xa Inhibitors); 0 (Pyrazoles); 0 (Pyridones); 3Z9Y7UWC1J (apixaban); A74586SNO7 (clopidogrel); OM90ZUW7M1 (Ticlopidine); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008693


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[PMID]:27778525
[Au] Autor:Brice AE; Hernandez GA; Sanchez M; Haynick M; Mendoza CE
[Ad] Endereço:a Division of Cardiology, Jackson Memorial Hospital , University of Miami Miller School of Medicine , Miami , FL , USA.
[Ti] Título:In-stent thrombosis when switching ticagrelor to clopidogrel after percutaneous coronary intervention.
[So] Source:Platelets;28(3):305-309, 2017 May.
[Is] ISSN:1369-1635
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Dual antiplatelet therapy with aspirin and a P2Y12 receptor blocker has been proven to reduce subsequent cardiovascular events and in-stent thrombosis in patients undergoing percutaneous coronary intervention. Newer P2Y12 antagonists with faster onset and greater inhibition of platelet activity have improved cardiovascular outcomes but have created uncertainty with the appropriate dosing when switching between agents. Currently, there are no evidence-based guidelines to aid clinicians when switching between P2Y12 receptor blockers. Here we describe two patients that developed in-stent thrombosis when switching from ticagrelor to clopidogrel using a 300 mg clopidogrel loading dose. Both patients presented with ST elevation myocardial infarction and underwent stent placement but then developed in-stent thrombosis 48 hours after switching from ticagrelor to clopidogrel. These cases illustrate the severe consequences of suboptimal platelet inhibition and the need for prospective trials thoroughly powered to assess clinical outcomes in order to determine the most appropriate strategy when switching from ticagrelor to clopidogrel.
[Mh] Termos MeSH primário: Adenosina/análogos & derivados
Substituição de Medicamentos/efeitos adversos
Intervenção Coronária Percutânea
Inibidores da Agregação de Plaquetas/uso terapêutico
Antagonistas do Receptor Purinérgico P2Y/uso terapêutico
Trombose/diagnóstico
Ticlopidina/análogos & derivados
[Mh] Termos MeSH secundário: Adenosina/uso terapêutico
Plaquetas/efeitos dos fármacos
Plaquetas/metabolismo
Plaquetas/patologia
Esquema de Medicação
Cálculos da Dosagem de Medicamento
Feminino
Seres Humanos
Masculino
Meia-Idade
Ativação Plaquetária/efeitos dos fármacos
Agregação Plaquetária/efeitos dos fármacos
Guias de Prática Clínica como Assunto
Infarto do Miocárdio com Supradesnível do Segmento ST/sangue
Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia
Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia
Stents
Trombose/etiologia
Trombose/patologia
Ticlopidina/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Platelet Aggregation Inhibitors); 0 (Purinergic P2Y Receptor Antagonists); A74586SNO7 (clopidogrel); GLH0314RVC (Ticagrelor); K72T3FS567 (Adenosine); OM90ZUW7M1 (Ticlopidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1080/09537104.2016.1235687


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[PMID]:29326304
[Au] Autor:Beales ILP
[Ad] Endereço:Norfolk and Norwich University Hospital, Norwich NR4 7UY, UK.
[Ti] Título:Gastrointestinal protection with dual antiplatelet therapies.
[So] Source:BMJ;360:j5410, 2018 01 11.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Inibidores da Agregação de Plaquetas
Ticlopidina
[Mh] Termos MeSH secundário: Aspirina
Quimioterapia Combinada
Seres Humanos
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Platelet Aggregation Inhibitors); OM90ZUW7M1 (Ticlopidine); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180113
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5410


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[PMID]:29382029
[Au] Autor:Ding L; Gu Z; Wang R; Li Y; Fang Y
[Ad] Endereço:Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School.
[Ti] Título:Acute stent thrombosis after stent-assisted coiling in an intracranial aneurysm patient carrying two reduced-function CYP2C19 alleles: A case report.
[So] Source:Medicine (Baltimore);96(47):e8920, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Stent thrombosis (ST) remains a thorny issue in spite of dual antiplatelet treatment with aspirin plus clopidogrel after stent-assisted coiling (SAC). We report a first case of acute ST after SAC in an intracranial aneurysm (IA) patient who carries two reduced-function CYP2C19 alleles. PATIENT CONCERNS: A 43-year-old Chinese male carrying two reduced-function CYP2C19 alleles was treated with a loading dose of clopidogrel 300 mg and aspirin 300 mg before SAC. Unfortunately, life-threatening ST appeared 0.5 h later after SAC. INTERVENTIONS: A total of 100000U of urokinase was used to dissolve ST. Meanwhile, tirofiban and nodroparin was also administrated to prevent recurrent thrombotic events. OUTCOMES: A repeated angiography demonstrated a successful reperfusion after thrombolytic treatment. LESSONS: The present case demonstrates that CYP2C19 allele carriers may lead to a suppressed antiplatelet effect of clopidogrel and a high risk of ST in the meantime. Therefore, CYP2C19 genetic testing seems to be able to identify patients-at-risk and optimal antiplatelet treatment should be considered in these fragile populations.
[Mh] Termos MeSH primário: Alelos
Citocromo P-450 CYP2C19/efeitos dos fármacos
Aneurisma Intracraniano/cirurgia
Stents/efeitos adversos
Trombose/etiologia
[Mh] Termos MeSH secundário: Adulto
Citocromo P-450 CYP2C19/genética
Seres Humanos
Aneurisma Intracraniano/tratamento farmacológico
Aneurisma Intracraniano/genética
Masculino
Variantes Farmacogenômicos
Inibidores da Agregação de Plaquetas/administração & dosagem
Ticlopidina/administração & dosagem
Ticlopidina/análogos & derivados
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Platelet Aggregation Inhibitors); A74586SNO7 (clopidogrel); EC 1.14.14.1 (CYP2C19 protein, human); EC 1.14.14.1 (Cytochrome P-450 CYP2C19); OM90ZUW7M1 (Ticlopidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008920


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[PMID]:29279531
[Au] Autor:Ozawa T; Suda M; Ikegami R; Takano T; Wakasugi T; Yanagawa T; Tanaka K; Ozaki K; Hirono S; Minamino T
[Ad] Endereço:Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences.
[Ti] Título:Dual Antiplatelet Therapy Guided by CYP2C19 Polymorphisms after Implantation of Second-Generation Drug-Eluting Stents for Management of Acute Coronary Syndrome.
[So] Source:Int Heart J;59(1):21-26, 2018 Jan 27.
[Is] ISSN:1349-3299
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:Prasugrel, a novel P2Y12 receptor inhibitor, is administered to patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), but it can increase the risk of bleeding. The Japanese exhibit weaker responses to clopidogrel than other races because of CYP2C19 polymorphisms; thus, it is unclear whether these patients should continue dual antiplatelet therapy (DAPT) using prasugrel or switch to clopidogrel in the chronic phase. Here we evaluated the clinical outcomes of DAPT guided by CYP2C19 polymorphisms after implantation of second-generation drug-eluting stents (DESs) for ACS management. Patients with ACS receiving PCI via DES from November 2011 to March 2015 were divided into two groups: conventional DAPT with clopidogrel (n = 41) and gene-guided DAPT (n = 24). In the gene-guided DAPT group, all patients with ACS were given DAPT using prasugrel as soon as possible; extensive and intermediate metabolizers receiving PCI for the first time were switched to clopidogrel at least 2 weeks after discharge, and intermediate metabolizers with repeated ACS and poor metabolizers continued on DAPT using prasugrel. Notably, gene-guided DAPT significantly reduced major adverse cardiovascular/cerebrovascular events (MACCEs; 22.0% versus 4.2%, hazard ratio [HR]: 0.15, 95% confidence interval [CI]: 0.01-0.81; P = 0.0247). Hemorrhagic complications were observed in 3.1% of patients receiving conventional DAPT and absent in the gene-guided group. Moreover, multivariate analysis showed that gene-guided DAPT significantly decreased MACCE incidence (HR: 0.15, 95% CI: 0.01-0.81; P = 0.033). Collectively, these data suggest that CYP2C19 polymorphism analysis may improve treatment decisions in patients with ACS receiving DES-PCI.
[Mh] Termos MeSH primário: Síndrome Coronariana Aguda/terapia
Citocromo P-450 CYP2C19/genética
Stents Farmacológicos
Intervenção Coronária Percutânea/efeitos adversos
Inibidores da Agregação de Plaquetas/administração & dosagem
Polimorfismo Genético
Complicações Pós-Operatórias/genética
[Mh] Termos MeSH secundário: Síndrome Coronariana Aguda/genética
Síndrome Coronariana Aguda/metabolismo
Idoso
Citocromo P-450 CYP2C19/metabolismo
DNA/genética
Relação Dose-Resposta a Droga
Quimioterapia Combinada
Feminino
Seguimentos
Seres Humanos
Incidência
Japão/epidemiologia
Masculino
Meia-Idade
Intervenção Coronária Percutânea/métodos
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/prevenção & controle
Cloridrato de Prasugrel/administração & dosagem
Estudos Retrospectivos
Acidente Vascular Cerebral/epidemiologia
Acidente Vascular Cerebral/genética
Acidente Vascular Cerebral/prevenção & controle
Ticlopidina/administração & dosagem
Ticlopidina/análogos & derivados
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Platelet Aggregation Inhibitors); 9007-49-2 (DNA); A74586SNO7 (clopidogrel); EC 1.14.14.1 (Cytochrome P-450 CYP2C19); G89JQ59I13 (Prasugrel Hydrochloride); OM90ZUW7M1 (Ticlopidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180206
[Lr] Data última revisão:
180206
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE
[do] DOI:10.1536/ihj.17-005


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[PMID]:28449426
[Au] Autor:Ryu DG; Choi CW; Kang DH; Kim HW; Jeong DI; Kim WC; Shin JG; Lim TW
[Ad] Endereço:Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
[Ti] Título:[A Case of Intramural Hematoma of the Esophagus Mimicking Acute Coronary Syndrome].
[So] Source:Korean J Gastroenterol;69(4):239-242, 2017 Apr 25.
[Is] ISSN:2233-6869
[Cp] País de publicação:Korea (South)
[La] Idioma:kor
[Ab] Resumo:Intramural hematoma of the esophagus is a rare condition that can be spontaneous or secondary to trauma, toxic ingestion, or intervention. If it is the spontaneous type, it usually presents initially with epigastric pain, hematemesis or dysphagia. We present a case of intramural hematoma of the esophagus mimicking acute coronary syndrome. A 63-year-old man presented with severe acute chest pain. He has four coronary stents that were inserted five years ago, from a different hospital, and is on dual antiplatelet agents. Coronary angiography was performed immediately under the suspicion of acute coronary syndrome, and we found that there was no obvious clogging of the coronary arteries. Next, chest computed tomography was performed due to suspected aortic dissection, and the result was also negative. Four days later, endoscopy was performed and intramural hematoma covered with large ulcers was diagnosed.
[Mh] Termos MeSH primário: Doenças do Esôfago/diagnóstico
Hematoma/diagnóstico
[Mh] Termos MeSH secundário: Síndrome Coronariana Aguda/diagnóstico
Diagnóstico Diferencial
Endoscopia Gastrointestinal
Doenças do Esôfago/tratamento farmacológico
Esôfago/patologia
Hematoma/tratamento farmacológico
Seres Humanos
Masculino
Meia-Idade
Inibidores da Agregação de Plaquetas/uso terapêutico
Ticlopidina/análogos & derivados
Ticlopidina/uso terapêutico
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS
[Nm] Nome de substância:
0 (Platelet Aggregation Inhibitors); A74586SNO7 (clopidogrel); OM90ZUW7M1 (Ticlopidine)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180102
[Lr] Data última revisão:
180102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.4166/kjg.2017.69.4.239


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[PMID]:29206871
[Au] Autor:Denslow A; Switalska M; Jarosz J; Papiernik D; Porshneva K; Nowak M; Wietrzyk J
[Ad] Endereço:Department of Experimental Oncology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland.
[Ti] Título:Clopidogrel in a combined therapy with anticancer drugs-effect on tumor growth, metastasis, and treatment toxicity: Studies in animal models.
[So] Source:PLoS One;12(12):e0188740, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Clopidogrel, a thienopyridine derivative with antiplatelet activity, is widely prescribed for patients with cardiovascular diseases. In addition to antiplatelet activity, antiplatelet agents possess anticancer and antimetastatic properties. Contrary to this, results of some studies have suggested that the use of clopidogrel and other thienopyridines accelerates the progression of breast, colorectal, and prostate cancer. Therefore, in this study, we aimed to evaluate the efficacy of clopidogrel and various anticancer agents as a combined treatment using mouse models of breast, colorectal, and prostate cancer. Metastatic dissemination, selected parameters of platelet morphology and biochemistry, as well as angiogenesis were assessed. In addition, body weight, blood morphology, and biochemistry were evaluated to test toxicity of the studied compounds. According to the results, clopidogrel increased antitumor and/or antimetastatic activity of chemotherapeutics such as 5-fluorouracil, cyclophosphamide, and mitoxantrone, whereas it decreased the anticancer activity of doxorubicin, cisplatin, and tamoxifen. The mechanisms of such divergent activities may be based on the modulation of tumor vasculature via factors, such as transforming growth factor ß1 released from platelets. Moreover, clopidogrel increased the toxicity of docetaxel and protected against mitoxantrone-induced toxicity, which may be due to the modulation of hepatic enzymes and protection of the vasculature, respectively. These results demonstrate that antiplatelet agents can be useful but also dangerous in anticancer treatment and therefore use of thienopyridines in patients undergoing chemotherapy should be carefully evaluated.
[Mh] Termos MeSH primário: Antineoplásicos/uso terapêutico
Neoplasias Experimentais/tratamento farmacológico
Neoplasias Experimentais/patologia
Inibidores da Agregação de Plaquetas/farmacologia
Ticlopidina/análogos & derivados
[Mh] Termos MeSH secundário: Animais
Linhagem Celular Tumoral
Fluoruracila/farmacologia
Seres Humanos
Masculino
Camundongos
Neoplasias da Próstata/patologia
Ticlopidina/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antineoplastic Agents); 0 (Platelet Aggregation Inhibitors); A74586SNO7 (clopidogrel); OM90ZUW7M1 (Ticlopidine); U3P01618RT (Fluorouracil)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171229
[Lr] Data última revisão:
171229
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188740


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[PMID]:28463896
[Au] Autor:Columbo JA; Lambour AJ; Sundling RA; Chauhan NB; Bessen SY; Linshaw DL; Kang R; Riblet NBV; Goodney PP; Stone DH
[Ad] Endereço:Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
[Ti] Título:A Meta-analysis of the Impact of Aspirin, Clopidogrel, and Dual Antiplatelet Therapy on Bleeding Complications in Noncardiac Surgery.
[So] Source:Ann Surg;267(1):1-10, 2018 Jan.
[Is] ISSN:1528-1140
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The aim of this study was to determine the bleeding risks associated with single (aspirin) and dual (aspirin + clopidogrel) antiplatelet therapy (DAPT) versus placebo or no treatment in adults undergoing noncardiac surgery. SUMMARY OF BACKGROUND DATA: The impact of antiplatelet therapy on bleeding during noncardiac surgery remains controversial. A meta-analysis was performed to examine the risk associated with single and DAPT. METHODS: A systematic review of antiplatelet therapy, noncardiac surgery, and perioperative bleeding was performed. Peer-reviewed sources and meeting abstracts from relevant societies were queried. Studies without a control group, or those that only examined patients with coronary stents, were excluded. Primary endpoints were transfusion and reintervention for bleeding. RESULTS: Of 11,592 references, 46 studies met inclusion criteria. In a meta-analysis of >30,000 patients, the relative risk (RR) of transfusion versus control was 1.14 [95% confidence interval (CI) 1.03-1.26, P = 0.009] for aspirin, and 1.33 (1.15-1.55, P = 0.001) for DAPT. Clopidogrel had an elevated risk, but data were too heterogeneous to analyze. The RR of bleeding requiring reintervention was not significantly higher for any agent compared to control [RR 0.96 (0.76-1.22, P = 0.76) for aspirin, 1.84 (0.87-3.87, P = 0.11) for clopidogrel, and 1.51 (0.92-2.49, P = 0.1) for DAPT]. Subanalysis of thoracic and abdominal procedures was similar. There was no difference in RR for myocardial infarction [1.06 (0.79-1.43)], stroke [0.97 (0.71-1.33)], or mortality [0.97 (0.87-1.1)]. CONCLUSIONS: Antiplatelet therapy at the time of noncardiac surgery confers minimal bleeding risk with no difference in thrombotic complications. In many cases, it is safe to continue antiplatelet therapy in patients with important indications for their use.
[Mh] Termos MeSH primário: Aspirina/efeitos adversos
Perda Sanguínea Cirúrgica
Procedimentos Cirúrgicos Operatórios/efeitos adversos
Ticlopidina/análogos & derivados
[Mh] Termos MeSH secundário: Aspirina/administração & dosagem
Quimioterapia Combinada
Seres Humanos
Inibidores da Agregação de Plaquetas/administração & dosagem
Fatores de Risco
Ticlopidina/administração & dosagem
Ticlopidina/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Platelet Aggregation Inhibitors); A74586SNO7 (clopidogrel); OM90ZUW7M1 (Ticlopidine); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1097/SLA.0000000000002279



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