The Experts below are selected from a list of 315 Experts worldwide ranked by ideXlab platform
Richard I. Hall - One of the best experts on this subject based on the ideXlab platform.
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Antiplatelet Drugs: a review of their pharmacology and management in the perioperative period.
Anesthesia and analgesia, 2011Co-Authors: Richard I. Hall, C. David MazerAbstract:In the normal course of the delivery of care, anesthesiologists encounter many patients who are receiving Drugs that affect platelet function as a fundamental part of primary and secondary management of atherosclerotic thrombotic disease. There are several Antiplatelet Drugs available for use in clinical practice and several under investigation. Aspirin and clopidogrel (alone and in combination) have been the most studied and have the most favorable risk-benefit profiles of Drugs currently available. Prasugrel was recently approved for patients with acute coronary syndrome undergoing percutaneous interventions. Other Drugs such as dipyridamole and cilostazol have not been as extensively investigated. There are several newer investigational Drugs such as cangrelor and ticagrelor, but whether they confer significant additional benefits remains to be established. Management of patients who are receiving Antiplatelet Drugs during the perioperative period requires an understanding of the underlying pathology and rationale for their administration, pharmacology and pharmacokinetics, and drug interactions. Furthermore, the risk and benefit assessment of discontinuing or continuing these Drugs should be made bearing in mind the proposed surgery and its inherent risk for bleeding complications as well as decisions relating to appropriate use of general or some form of regional anesthesia. In general, the safest approach to prevent thrombosis seems to be continuation of these Drugs throughout the perioperative period except where concerns about perioperative bleeding outweigh those associated with the development of thrombotic occlusion. Knowledge of the pharmacodynamics and pharmacokinetics of Antiplatelet Drugs may allow practitioners to anticipate difficulties associated with drug withdrawal and administration in the perioperative period including the potential for drug interactions.
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Antiplatelet Drugs a review of their pharmacology and management in the perioperative period
Anesthesia & Analgesia, 2011Co-Authors: Richard I. Hall, David C MazerAbstract:In the normal course of the delivery of care, anesthesiologists encounter many patients who are receiving Drugs that affect platelet function as a fundamental part of primary and secondary management of atherosclerotic thrombotic disease. There are several Antiplatelet Drugs available for use in cli
Matteo Nicola Dario Di Minno - One of the best experts on this subject based on the ideXlab platform.
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Perioperative handling of Antiplatelet Drugs. A critical appraisal.
Current drug targets, 2013Co-Authors: Matteo Nicola Dario Di Minno, Marco Milone, P. Mastronardi, Pasquale Ambrosino, Alessandro Di Minno, Alessandro Parolari, Elena Tremoli, Domenico PriscoAbstract:Because of more and more accurate cardiovascular prevention programs and the increasing mean age of the general population, the use of Antiplatelet treatments is progressively increasing in the last years. Moreover, the wide-spread use of bare-metal stents (BMS) and drug-eluting stents (DES) significantly increased the number of subjects with the need of a combined Antiplatelet treatment: Aspirin (ASA) and Clopidogrel (CLO. Within the first year after coronary stenting, approximately 5% of patients needs to undergo non-cardiac surgery interventions. In such patients, current guidelines suggest to stop Antiplatelet agents 7-10 days before surgery to avoid the risk of increasing blood loss. On the other hand, it has been shown that the risk of surgical bleeding, if Antiplatelet Drugs are continued, is lower than that of coronary thrombosis if they are withdrawn. Thus, an accurate stratification of the population according to the thrombotic risk is needed and the bleeding and the thrombotic risk should be considered in parallel. Although a growing amount of recommendations have been released by several Societies, the perioperative handling of Antiplatelet Drugs still represents a major concern in clinical practice. In this review we report the major literature data about the perioperative handling of Antiplatelet Drugs. Moreover, in order to describe future treatment perspectives and to identify valuable alternatives to current Antiplatelet agents in the perioperative period, pharmacokinetic and pharmacodynamic characteristics of newer Antiplatelet Drugs are reported and analyzed.
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Stroke prevention: from available Antiplatelet Drugs to novel molecular targets.
Current drug targets, 2013Co-Authors: Matteo Nicola Dario Di Minno, Alessandro Di Minno, Stefania Momi, Anna RussolilloAbstract:Stroke is the third most common cause of death in the industrialized countries and adequate primary and secondary prevention strategies are mandatory. In addition to lifestyle-changes and correction of cardiovascular risk factors, the mainstay of the atherothrombotic stroke prevention is represented by Antiplatelet treatment. Although aspirin and thienopyridines have proved their efficacy in the prevention of arterial thrombotic events, limited efficacy, increased risk of bleeding, significant inter-individual variability in the response and extended duration of action that cannot be reversed if the need for haemostasis or emergency surgery arises represent major limitations of these Drugs. Moreover, despite recommendations and guidelines about stroke prevention, registries data clearly suggest an underuse of Antiplatelet Drugs, mainly because of bleeding episodes fear. At variance with newer anticoagulant Drugs, which showed a series of advantages as compared with the traditional warfarin treatment, newer Antiplatelet Drugs have only partially overcome these limitations. Although ad hoc studies on their efficacy in the stroke prevention are currently lacking, newer Antiplatelet agents (mainly ticagrelor and prasugrel) do not provide a significant better protection over and above aspirin and/or clopidogrel in the prevention of atherothrombotic stroke. In addition, a significantly increased bleeding risk has been reported in subjects receiving these new thienopyridines. According to these data, the identification of further molecular targets is needed, in order to design future Antiplatelet Drugs. In this review, after summarizing major literature data about traditional and newer Antiplatelet Drugs, we will specifically focus on novel potential target candidates for Antiplatelet therapy.
C. David Mazer - One of the best experts on this subject based on the ideXlab platform.
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Antiplatelet Drugs: a review of their pharmacology and management in the perioperative period.
Anesthesia and analgesia, 2011Co-Authors: Richard I. Hall, C. David MazerAbstract:In the normal course of the delivery of care, anesthesiologists encounter many patients who are receiving Drugs that affect platelet function as a fundamental part of primary and secondary management of atherosclerotic thrombotic disease. There are several Antiplatelet Drugs available for use in clinical practice and several under investigation. Aspirin and clopidogrel (alone and in combination) have been the most studied and have the most favorable risk-benefit profiles of Drugs currently available. Prasugrel was recently approved for patients with acute coronary syndrome undergoing percutaneous interventions. Other Drugs such as dipyridamole and cilostazol have not been as extensively investigated. There are several newer investigational Drugs such as cangrelor and ticagrelor, but whether they confer significant additional benefits remains to be established. Management of patients who are receiving Antiplatelet Drugs during the perioperative period requires an understanding of the underlying pathology and rationale for their administration, pharmacology and pharmacokinetics, and drug interactions. Furthermore, the risk and benefit assessment of discontinuing or continuing these Drugs should be made bearing in mind the proposed surgery and its inherent risk for bleeding complications as well as decisions relating to appropriate use of general or some form of regional anesthesia. In general, the safest approach to prevent thrombosis seems to be continuation of these Drugs throughout the perioperative period except where concerns about perioperative bleeding outweigh those associated with the development of thrombotic occlusion. Knowledge of the pharmacodynamics and pharmacokinetics of Antiplatelet Drugs may allow practitioners to anticipate difficulties associated with drug withdrawal and administration in the perioperative period including the potential for drug interactions.
Alessandro Di Minno - One of the best experts on this subject based on the ideXlab platform.
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Perioperative handling of Antiplatelet Drugs. A critical appraisal.
Current drug targets, 2013Co-Authors: Matteo Nicola Dario Di Minno, Marco Milone, P. Mastronardi, Pasquale Ambrosino, Alessandro Di Minno, Alessandro Parolari, Elena Tremoli, Domenico PriscoAbstract:Because of more and more accurate cardiovascular prevention programs and the increasing mean age of the general population, the use of Antiplatelet treatments is progressively increasing in the last years. Moreover, the wide-spread use of bare-metal stents (BMS) and drug-eluting stents (DES) significantly increased the number of subjects with the need of a combined Antiplatelet treatment: Aspirin (ASA) and Clopidogrel (CLO. Within the first year after coronary stenting, approximately 5% of patients needs to undergo non-cardiac surgery interventions. In such patients, current guidelines suggest to stop Antiplatelet agents 7-10 days before surgery to avoid the risk of increasing blood loss. On the other hand, it has been shown that the risk of surgical bleeding, if Antiplatelet Drugs are continued, is lower than that of coronary thrombosis if they are withdrawn. Thus, an accurate stratification of the population according to the thrombotic risk is needed and the bleeding and the thrombotic risk should be considered in parallel. Although a growing amount of recommendations have been released by several Societies, the perioperative handling of Antiplatelet Drugs still represents a major concern in clinical practice. In this review we report the major literature data about the perioperative handling of Antiplatelet Drugs. Moreover, in order to describe future treatment perspectives and to identify valuable alternatives to current Antiplatelet agents in the perioperative period, pharmacokinetic and pharmacodynamic characteristics of newer Antiplatelet Drugs are reported and analyzed.
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Stroke prevention: from available Antiplatelet Drugs to novel molecular targets.
Current drug targets, 2013Co-Authors: Matteo Nicola Dario Di Minno, Alessandro Di Minno, Stefania Momi, Anna RussolilloAbstract:Stroke is the third most common cause of death in the industrialized countries and adequate primary and secondary prevention strategies are mandatory. In addition to lifestyle-changes and correction of cardiovascular risk factors, the mainstay of the atherothrombotic stroke prevention is represented by Antiplatelet treatment. Although aspirin and thienopyridines have proved their efficacy in the prevention of arterial thrombotic events, limited efficacy, increased risk of bleeding, significant inter-individual variability in the response and extended duration of action that cannot be reversed if the need for haemostasis or emergency surgery arises represent major limitations of these Drugs. Moreover, despite recommendations and guidelines about stroke prevention, registries data clearly suggest an underuse of Antiplatelet Drugs, mainly because of bleeding episodes fear. At variance with newer anticoagulant Drugs, which showed a series of advantages as compared with the traditional warfarin treatment, newer Antiplatelet Drugs have only partially overcome these limitations. Although ad hoc studies on their efficacy in the stroke prevention are currently lacking, newer Antiplatelet agents (mainly ticagrelor and prasugrel) do not provide a significant better protection over and above aspirin and/or clopidogrel in the prevention of atherothrombotic stroke. In addition, a significantly increased bleeding risk has been reported in subjects receiving these new thienopyridines. According to these data, the identification of further molecular targets is needed, in order to design future Antiplatelet Drugs. In this review, after summarizing major literature data about traditional and newer Antiplatelet Drugs, we will specifically focus on novel potential target candidates for Antiplatelet therapy.
Anna Russolillo - One of the best experts on this subject based on the ideXlab platform.
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Stroke prevention: from available Antiplatelet Drugs to novel molecular targets.
Current drug targets, 2013Co-Authors: Matteo Nicola Dario Di Minno, Alessandro Di Minno, Stefania Momi, Anna RussolilloAbstract:Stroke is the third most common cause of death in the industrialized countries and adequate primary and secondary prevention strategies are mandatory. In addition to lifestyle-changes and correction of cardiovascular risk factors, the mainstay of the atherothrombotic stroke prevention is represented by Antiplatelet treatment. Although aspirin and thienopyridines have proved their efficacy in the prevention of arterial thrombotic events, limited efficacy, increased risk of bleeding, significant inter-individual variability in the response and extended duration of action that cannot be reversed if the need for haemostasis or emergency surgery arises represent major limitations of these Drugs. Moreover, despite recommendations and guidelines about stroke prevention, registries data clearly suggest an underuse of Antiplatelet Drugs, mainly because of bleeding episodes fear. At variance with newer anticoagulant Drugs, which showed a series of advantages as compared with the traditional warfarin treatment, newer Antiplatelet Drugs have only partially overcome these limitations. Although ad hoc studies on their efficacy in the stroke prevention are currently lacking, newer Antiplatelet agents (mainly ticagrelor and prasugrel) do not provide a significant better protection over and above aspirin and/or clopidogrel in the prevention of atherothrombotic stroke. In addition, a significantly increased bleeding risk has been reported in subjects receiving these new thienopyridines. According to these data, the identification of further molecular targets is needed, in order to design future Antiplatelet Drugs. In this review, after summarizing major literature data about traditional and newer Antiplatelet Drugs, we will specifically focus on novel potential target candidates for Antiplatelet therapy.