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Frans Van De Werf - One of the best experts on this subject based on the ideXlab platform.

  • balancing benefit and bleeding risk of Antithrombotic Agents in the individual patient with an acute coronary syndrome
    Circulation, 2010
    Co-Authors: Frans Van De Werf
    Abstract:

    In most countries, the Antithrombotic armamentarium for treating acute coronary syndrome (ACS) patients currently consists of aspirin, clopidogrel, heparin, enoxaparin, bivalirudin, and fondaparinux. A large number of new Antithrombotic Agents for treating ACS patients are about to enter the market or are under development: new P2Y12 inhibitors (prasugrel, ticagrelor, cangrelor), thrombin receptor (proteinase-activator receptor-1) antagonists (SCH 530348, E555), direct antithrombin (dabigatran), and anti-Xa Agents (otamixaban, rivaroxaban, apixaban).1 For all these new Agents, there is evidence of enhanced or additional Antithrombotic efficacy compared with standard Antithrombotic regimens. A remaining clinical challenge of major importance is the price to be paid in terms of extra bleeding complications. For example, although there is very convincing evidence that prasugrel reduces the risk of stent thrombosis compared with clopidogrel, the practicing physician might be hesitant to put a particular ACS patient undergoing percutaneous coronary intervention on prasugrel because of the increased risk of a major or even fatal bleeding complication as demonstrated in the total population treated with prasugrel in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel (TRITON).2 What the practicing physician would like to know is, In which patients does the reduced risk of stent thrombosis with prasugrel by far outweigh the risk of a severe and possibly fatal bleeding? Article see p 43 Risk factors for bleeding complications have been identified in several previous studies: eg, age,3 female gender,3,4 renal impairment,3,4 and previous bleeding.3 Some of these risk factors such as age, renal failure, and hypertension have been shown in large registries to also be risk factors for recurrent ischemic events and death (summarized, for instance, by Gale et al5 and Diez and Cohen6). Thus, identifying these risk factors in a particular patient is not very helpful. In …

  • new Antithrombotic Agents are they needed and what can they offer to patients with a non st elevation acute coronary syndrome
    European Heart Journal, 2009
    Co-Authors: Frans Van De Werf
    Abstract:

    Antithrombotic therapy is a cornerstone of treatment for non-ST-segment elevation acute coronary syndromes, as demonstrated in numerous clinical trials. Long-term oral antiplatelet therapy targeting specific platelet activation pathways has demonstrated significant long-term benefits, whereas antithrombin use is limited to the acute setting. Despite proven efficacy of long-term dual oral antiplatelet therapy with aspirin and clopidogrel, residual morbidity and mortality is considerable. This may be partly due to incomplete inhibition of platelet activation with current Agents and/or lack of long-term anticoagulant therapy. Improvements in patient outcomes could be achieved by developing Agents that inhibit other platelet activation pathways or by adding new anticoagulants such as oral anti-IIa or anti-Xa Agents for a prolonged period of time after the acute event. This review describes the rationale behind and the current status of the trials with new Antithrombotic Agents.

Noboru Kawata - One of the best experts on this subject based on the ideXlab platform.

  • efficacy of polyglycolic acid sheets and fibrin glue for prevention of bleeding after gastric endoscopic submucosal dissection in patients under continued Antithrombotic Agents
    Gastric Cancer, 2018
    Co-Authors: Noboru Kawata, Hiroyuki Ono, Kohei Takizawa, Naomi Kakushima, Masaki Tanaka, Kimihiro Igarashi, Masao Yoshida, Yoshihiro Kishida, Tomohiro Iwai, Sayo Ito
    Abstract:

    A novel method for the prevention of bleeding after gastric endoscopic submucosal dissection (ESD) is necessary, as the numbers of patients taking Antithrombotic Agents have increased. This study aimed to assess the efficacy and safety of the covering method using polyglycolic acid (PGA) sheets and fibrin glue for ESD-induced ulcer in preventing post-ESD bleeding in patients under continued Antithrombotic Agents. One hundred five consecutive gastric tumors among 84 patients who were treated by ESD under continued Antithrombotic Agents between April 2014 and September 2015 were enrolled in this study. The patients were classified into two groups, the covering group (52 lesions among 38 patients; those with ESD in whom PGA sheets and fibrin glue were used as the covering method) and the control group (53 lesions among 46 patients; ESD only), and their post-ESD bleeding rates were compared. No significant differences were seen in the number and type of Antithrombotic Agents, lesion location, median procedure time, and median resected specimen size between the groups. ESD was completed in all cases, with no cases of uncontrollable bleeding during the procedure. Post-ESD bleeding occurred in 5.8% (3/52) and 20.8% (11/53) in the covering and control groups, respectively. The post-ESD bleeding rate significantly differed between the groups (P = 0.04; odds ratio, 0.23; 95% confidential interval, 0.06–0.89). No adverse events were associated with the use of PGA sheets and fibrin glue. The covering method using PGA sheets and fibrin glue has the potential to reduce post-ESD bleeding in patients receiving continued Antithrombotic Agents.

  • efficacy of polyglycolic acid sheets and fibrin glue for prevention of bleeding after gastric endoscopic submucosal dissection in patients under continued Antithrombotic Agents
    Gastric Cancer, 2018
    Co-Authors: Noboru Kawata, Kohei Takizawa, Naomi Kakushima, Masaki Tanaka, Kimihiro Igarashi, Masao Yoshida, Yoshihiro Kishida, Tomohiro Iwai, Kenichiro Imai, Kinichi Hotta
    Abstract:

    BACKGROUND: A novel method for the prevention of bleeding after gastric endoscopic submucosal dissection (ESD) is necessary, as the numbers of patients taking Antithrombotic Agents have increased. This study aimed to assess the efficacy and safety of the covering method using polyglycolic acid (PGA) sheets and fibrin glue for ESD-induced ulcer in preventing post-ESD bleeding in patients under continued Antithrombotic Agents. METHODS: One hundred five consecutive gastric tumors among 84 patients who were treated by ESD under continued Antithrombotic Agents between April 2014 and September 2015 were enrolled in this study. The patients were classified into two groups, the covering group (52 lesions among 38 patients; those with ESD in whom PGA sheets and fibrin glue were used as the covering method) and the control group (53 lesions among 46 patients; ESD only), and their post-ESD bleeding rates were compared. RESULTS: No significant differences were seen in the number and type of Antithrombotic Agents, lesion location, median procedure time, and median resected specimen size between the groups. ESD was completed in all cases, with no cases of uncontrollable bleeding during the procedure. Post-ESD bleeding occurred in 5.8% (3/52) and 20.8% (11/53) in the covering and control groups, respectively. The post-ESD bleeding rate significantly differed between the groups (P = 0.04; odds ratio, 0.23; 95% confidential interval, 0.06-0.89). No adverse events were associated with the use of PGA sheets and fibrin glue. CONCLUSIONS: The covering method using PGA sheets and fibrin glue has the potential to reduce post-ESD bleeding in patients receiving continued Antithrombotic Agents.

Sayo Ito - One of the best experts on this subject based on the ideXlab platform.

  • efficacy of polyglycolic acid sheets and fibrin glue for prevention of bleeding after gastric endoscopic submucosal dissection in patients under continued Antithrombotic Agents
    Gastric Cancer, 2018
    Co-Authors: Noboru Kawata, Hiroyuki Ono, Kohei Takizawa, Naomi Kakushima, Masaki Tanaka, Kimihiro Igarashi, Masao Yoshida, Yoshihiro Kishida, Tomohiro Iwai, Sayo Ito
    Abstract:

    A novel method for the prevention of bleeding after gastric endoscopic submucosal dissection (ESD) is necessary, as the numbers of patients taking Antithrombotic Agents have increased. This study aimed to assess the efficacy and safety of the covering method using polyglycolic acid (PGA) sheets and fibrin glue for ESD-induced ulcer in preventing post-ESD bleeding in patients under continued Antithrombotic Agents. One hundred five consecutive gastric tumors among 84 patients who were treated by ESD under continued Antithrombotic Agents between April 2014 and September 2015 were enrolled in this study. The patients were classified into two groups, the covering group (52 lesions among 38 patients; those with ESD in whom PGA sheets and fibrin glue were used as the covering method) and the control group (53 lesions among 46 patients; ESD only), and their post-ESD bleeding rates were compared. No significant differences were seen in the number and type of Antithrombotic Agents, lesion location, median procedure time, and median resected specimen size between the groups. ESD was completed in all cases, with no cases of uncontrollable bleeding during the procedure. Post-ESD bleeding occurred in 5.8% (3/52) and 20.8% (11/53) in the covering and control groups, respectively. The post-ESD bleeding rate significantly differed between the groups (P = 0.04; odds ratio, 0.23; 95% confidential interval, 0.06–0.89). No adverse events were associated with the use of PGA sheets and fibrin glue. The covering method using PGA sheets and fibrin glue has the potential to reduce post-ESD bleeding in patients receiving continued Antithrombotic Agents.

Kinichi Hotta - One of the best experts on this subject based on the ideXlab platform.

  • efficacy of polyglycolic acid sheets and fibrin glue for prevention of bleeding after gastric endoscopic submucosal dissection in patients under continued Antithrombotic Agents
    Gastric Cancer, 2018
    Co-Authors: Noboru Kawata, Kohei Takizawa, Naomi Kakushima, Masaki Tanaka, Kimihiro Igarashi, Masao Yoshida, Yoshihiro Kishida, Tomohiro Iwai, Kenichiro Imai, Kinichi Hotta
    Abstract:

    BACKGROUND: A novel method for the prevention of bleeding after gastric endoscopic submucosal dissection (ESD) is necessary, as the numbers of patients taking Antithrombotic Agents have increased. This study aimed to assess the efficacy and safety of the covering method using polyglycolic acid (PGA) sheets and fibrin glue for ESD-induced ulcer in preventing post-ESD bleeding in patients under continued Antithrombotic Agents. METHODS: One hundred five consecutive gastric tumors among 84 patients who were treated by ESD under continued Antithrombotic Agents between April 2014 and September 2015 were enrolled in this study. The patients were classified into two groups, the covering group (52 lesions among 38 patients; those with ESD in whom PGA sheets and fibrin glue were used as the covering method) and the control group (53 lesions among 46 patients; ESD only), and their post-ESD bleeding rates were compared. RESULTS: No significant differences were seen in the number and type of Antithrombotic Agents, lesion location, median procedure time, and median resected specimen size between the groups. ESD was completed in all cases, with no cases of uncontrollable bleeding during the procedure. Post-ESD bleeding occurred in 5.8% (3/52) and 20.8% (11/53) in the covering and control groups, respectively. The post-ESD bleeding rate significantly differed between the groups (P = 0.04; odds ratio, 0.23; 95% confidential interval, 0.06-0.89). No adverse events were associated with the use of PGA sheets and fibrin glue. CONCLUSIONS: The covering method using PGA sheets and fibrin glue has the potential to reduce post-ESD bleeding in patients receiving continued Antithrombotic Agents.

William Wijns - One of the best experts on this subject based on the ideXlab platform.