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Michel E Mawad - One of the best experts on this subject based on the ideXlab platform.
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dual antiplatelet therapy monitoring for neurointerventional procedures using a point of care platelet function test a single center experience
American Journal of Neuroradiology, 2008Co-Authors: Anil Arat, Hisham Morsi, Hashem Shaltoni, J. R. Harris, Michel E MawadAbstract:BACKGROUND AND PURPOSE: Growing evidence of the relationship between poor antiplatelet response and occurrence of clinical events elicited the need of monitoring the response which has not been part of our daily practice. We present our initial experience with a new point-of-care antiplatelet-function test (VerifyNow assay) in neurointerventional procedures. MATERIALS AND METHODS: Among the 106 consecutive patients from July 2006 to April 2007, ninety-eight met the inclusion criteria. Our preferred antiplatelet regimen was Aspirin (325 mg daily) and clopidogrel (300 mg of loading dose followed by 75 mg daily) starting 5-10 days before the procedure. The test results were reported as Aspirin-Reaction unit (ARU) for Aspirin and P2Y(12) Reaction units (PRU), baseline (BASE), and percentage inhibition for the P2Y(12) assay and were summarized as mean +/- SD of the values. We analyzed the effects of several factors of poor clopidogrel response (<40% inhibition). The occurrence of thrombotic events was recorded. RESULTS: The mean ARU of Aspirin assays was 438.3 +/- 47.9 (range, 350-632), and the response was poor in 2 patients (2.1%). For clopidogrel, the mean of the BASE, PRU, and percentage inhibition was 356.8 +/- 56.3 (range, 234-495), 198.9 +/- 104.4 (range, 8-401), and 45.2 +/- 27.1% (range, 0-98), respectively. Forty-two patients (42.9%) showed poor response. Multivariate analysis showed greater body weight (81.9 Kg +/- 19.1 kg versus 69.9 +/- 15 kg) in the poor-response group. All 3 cases of intraprocedural thrombosis (3.1%) were observed only in the poor-response group. CONCLUSION: We observed a high frequency of poor clopidogrel responses in the neurointerventional setting. Routine monitoring of the drug response would be helpful for the early identification of poor antiplatelet responders so that we may modify the regimen and/or treatment plan.
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dual antiplatelet therapy monitoring for neurointerventional procedures using a point of care platelet function test a single center experience
American Journal of Neuroradiology, 2008Co-Authors: Deok Hee Lee, Hashem Shaltoni, Anil Arat, J. R. Harris, Hesham Morsi, Michel E MawadAbstract:BACKGROUND AND PURPOSE: Growing evidence of the relationship between poor antiplatelet response and occurrence of clinical events elicited the need of monitoring the response which has not been part of our daily practice. We present our initial experience with a new point-of-care antiplatelet-function test (VerifyNow assay) in neurointerventional procedures. MATERIALS AND METHODS: Among the 106 consecutive patients from July 2006 to April 2007, ninety-eight met the inclusion criteria. Our preferred antiplatelet regimen was Aspirin (325 mg daily) and clopidogrel (300 mg of loading dose followed by 75 mg daily) starting 5–10 days before the procedure. The test results were reported as Aspirin-Reaction unit (ARU) for Aspirin and P2Y 12 Reaction units (PRU), baseline (BASE), and percentage inhibition for the P2Y 12 assay and were summarized as mean ± SD of the values. We analyzed the effects of several factors of poor clopidogrel response ( RESULTS: The mean ARU of Aspirin assays was 438.3 ± 47.9 (range, 350–632), and the response was poor in 2 patients (2.1%). For clopidogrel, the mean of the BASE, PRU, and percentage inhibition was 356.8 ± 56.3 (range, 234–495), 198.9 ± 104.4 (range, 8–401), and 45.2 ± 27.1% (range, 0–98), respectively. Forty-two patients (42.9%) showed poor response. Multivariate analysis showed greater body weight (81.9 Kg ± 19.1 kg versus 69.9 ± 15 kg) in the poor-response group. All 3 cases of intraprocedural thrombosis (3.1%) were observed only in the poor-response group. CONCLUSION: We observed a high frequency of poor clopidogrel responses in the neurointerventional setting. Routine monitoring of the drug response would be helpful for the early identification of poor antiplatelet responders so that we may modify the regimen and/or treatment plan.
Anil Arat - One of the best experts on this subject based on the ideXlab platform.
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dual antiplatelet therapy monitoring for neurointerventional procedures using a point of care platelet function test a single center experience
American Journal of Neuroradiology, 2008Co-Authors: Anil Arat, Hisham Morsi, Hashem Shaltoni, J. R. Harris, Michel E MawadAbstract:BACKGROUND AND PURPOSE: Growing evidence of the relationship between poor antiplatelet response and occurrence of clinical events elicited the need of monitoring the response which has not been part of our daily practice. We present our initial experience with a new point-of-care antiplatelet-function test (VerifyNow assay) in neurointerventional procedures. MATERIALS AND METHODS: Among the 106 consecutive patients from July 2006 to April 2007, ninety-eight met the inclusion criteria. Our preferred antiplatelet regimen was Aspirin (325 mg daily) and clopidogrel (300 mg of loading dose followed by 75 mg daily) starting 5-10 days before the procedure. The test results were reported as Aspirin-Reaction unit (ARU) for Aspirin and P2Y(12) Reaction units (PRU), baseline (BASE), and percentage inhibition for the P2Y(12) assay and were summarized as mean +/- SD of the values. We analyzed the effects of several factors of poor clopidogrel response (<40% inhibition). The occurrence of thrombotic events was recorded. RESULTS: The mean ARU of Aspirin assays was 438.3 +/- 47.9 (range, 350-632), and the response was poor in 2 patients (2.1%). For clopidogrel, the mean of the BASE, PRU, and percentage inhibition was 356.8 +/- 56.3 (range, 234-495), 198.9 +/- 104.4 (range, 8-401), and 45.2 +/- 27.1% (range, 0-98), respectively. Forty-two patients (42.9%) showed poor response. Multivariate analysis showed greater body weight (81.9 Kg +/- 19.1 kg versus 69.9 +/- 15 kg) in the poor-response group. All 3 cases of intraprocedural thrombosis (3.1%) were observed only in the poor-response group. CONCLUSION: We observed a high frequency of poor clopidogrel responses in the neurointerventional setting. Routine monitoring of the drug response would be helpful for the early identification of poor antiplatelet responders so that we may modify the regimen and/or treatment plan.
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dual antiplatelet therapy monitoring for neurointerventional procedures using a point of care platelet function test a single center experience
American Journal of Neuroradiology, 2008Co-Authors: Deok Hee Lee, Hashem Shaltoni, Anil Arat, J. R. Harris, Hesham Morsi, Michel E MawadAbstract:BACKGROUND AND PURPOSE: Growing evidence of the relationship between poor antiplatelet response and occurrence of clinical events elicited the need of monitoring the response which has not been part of our daily practice. We present our initial experience with a new point-of-care antiplatelet-function test (VerifyNow assay) in neurointerventional procedures. MATERIALS AND METHODS: Among the 106 consecutive patients from July 2006 to April 2007, ninety-eight met the inclusion criteria. Our preferred antiplatelet regimen was Aspirin (325 mg daily) and clopidogrel (300 mg of loading dose followed by 75 mg daily) starting 5–10 days before the procedure. The test results were reported as Aspirin-Reaction unit (ARU) for Aspirin and P2Y 12 Reaction units (PRU), baseline (BASE), and percentage inhibition for the P2Y 12 assay and were summarized as mean ± SD of the values. We analyzed the effects of several factors of poor clopidogrel response ( RESULTS: The mean ARU of Aspirin assays was 438.3 ± 47.9 (range, 350–632), and the response was poor in 2 patients (2.1%). For clopidogrel, the mean of the BASE, PRU, and percentage inhibition was 356.8 ± 56.3 (range, 234–495), 198.9 ± 104.4 (range, 8–401), and 45.2 ± 27.1% (range, 0–98), respectively. Forty-two patients (42.9%) showed poor response. Multivariate analysis showed greater body weight (81.9 Kg ± 19.1 kg versus 69.9 ± 15 kg) in the poor-response group. All 3 cases of intraprocedural thrombosis (3.1%) were observed only in the poor-response group. CONCLUSION: We observed a high frequency of poor clopidogrel responses in the neurointerventional setting. Routine monitoring of the drug response would be helpful for the early identification of poor antiplatelet responders so that we may modify the regimen and/or treatment plan.
Chupak Lau - One of the best experts on this subject based on the ideXlab platform.
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Aspirin resistance and adverse clinical events in patients with coronary artery disease
The American Journal of Medicine, 2007Co-Authors: Waihong Chen, Xi Cheng, Puiyin Lee, Jeanette Yatyin Kwok, Hungfat Tse, Chupak LauAbstract:Abstract Purpose We sought to determine the clinical significance of Aspirin resistance measured by a point-of-care assay in stable patients with coronary artery disease (CAD). Methods We used the VerifyNow Aspirin (Accumetrics Inc, San Diego, Calif) to determine Aspirin responsiveness of 468 stable CAD patients on Aspirin 80 to 325 mg daily for ≥4 weeks. Aspirin resistance was defined as an Aspirin Reaction Unit ≥550. The primary outcome was the composite of cardiovascular death, myocardial infarction (MI), unstable angina requiring hospitalization, stroke, and transient ischemic attack. Results Aspirin resistance was noted in 128 (27.4%) patients. After a mean follow-up of 379±200 days, patients with Aspirin resistance were at increased risk of the composite outcome compared to patients who were Aspirin-sensitive (15.6% vs 5.3%, hazard ratio [HR] 3.12, 95% confidence intervals [CI], 1.65-5.91, P P = .007). Conclusions Aspirin resistance, defined by an aggregation-based rapid platelet function assay, is associated with an increased risk of adverse clinical outcomes in stable patients with CAD.
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low dose Aspirin increases Aspirin resistance in patients with coronary artery disease
The American Journal of Medicine, 2005Co-Authors: Puiyin Lee, Waihong Chen, Xi Cheng, Jeanette Yatyin Kwok, Hungfat Tse, Chupak LauAbstract:Abstract Purpose We sought to investigate the association of Aspirin dose and Aspirin resistance in stable coronary artery disease patients measured by a point-of-care assay. Methods We studied 468 consecutive stable coronary artery disease patients in a referral cardiac center who were taking Aspirin 80 to 325 mg daily for ≥4 weeks. The VerifyNow Aspirin (Ultegra RPFA-ASA, Accumetrics Inc, San Diego, Calif) was used to determine Aspirin responsiveness. An Aspirin Reaction unit (ARU) ≥550 indicates the absence of Aspirin-induced platelet dysfunction, based on correlation with epinephrine-induced light transmission aggregometry. Demographic and clinical data were collected to analyze the predictors of Aspirin resistance. Results Aspirin resistance was noted in 128 (27.4%) patients. Univariate predictors of Aspirin resistance include elderly ( P = 0.002), women ( P P P = 0.009) and Aspirin dose ≤100mg ( P = 0.004). Multivariate analysis revealed hemoglobin (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.51 to 0.69; P P = 0.022) to be independent predictors of Aspirin resistance. Daily Aspirin dose ≤ 100 mg was associated with increased prevalence of Aspirin resistance compared with 150 mg and 300 mg daily (30.2% vs 16.7% vs 0%, P = 0.0062). Conclusion A 100 mg or less daily dose of Aspirin, which may have lower side effects, is associated with a higher incidence of Aspirin resistance in patients with coronary artery disease. Prospective randomized studies are warranted to elucidate the optimal Aspirin dosage for preventing ischemic complications of atherothrombotic disease.
Hashem Shaltoni - One of the best experts on this subject based on the ideXlab platform.
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dual antiplatelet therapy monitoring for neurointerventional procedures using a point of care platelet function test a single center experience
American Journal of Neuroradiology, 2008Co-Authors: Anil Arat, Hisham Morsi, Hashem Shaltoni, J. R. Harris, Michel E MawadAbstract:BACKGROUND AND PURPOSE: Growing evidence of the relationship between poor antiplatelet response and occurrence of clinical events elicited the need of monitoring the response which has not been part of our daily practice. We present our initial experience with a new point-of-care antiplatelet-function test (VerifyNow assay) in neurointerventional procedures. MATERIALS AND METHODS: Among the 106 consecutive patients from July 2006 to April 2007, ninety-eight met the inclusion criteria. Our preferred antiplatelet regimen was Aspirin (325 mg daily) and clopidogrel (300 mg of loading dose followed by 75 mg daily) starting 5-10 days before the procedure. The test results were reported as Aspirin-Reaction unit (ARU) for Aspirin and P2Y(12) Reaction units (PRU), baseline (BASE), and percentage inhibition for the P2Y(12) assay and were summarized as mean +/- SD of the values. We analyzed the effects of several factors of poor clopidogrel response (<40% inhibition). The occurrence of thrombotic events was recorded. RESULTS: The mean ARU of Aspirin assays was 438.3 +/- 47.9 (range, 350-632), and the response was poor in 2 patients (2.1%). For clopidogrel, the mean of the BASE, PRU, and percentage inhibition was 356.8 +/- 56.3 (range, 234-495), 198.9 +/- 104.4 (range, 8-401), and 45.2 +/- 27.1% (range, 0-98), respectively. Forty-two patients (42.9%) showed poor response. Multivariate analysis showed greater body weight (81.9 Kg +/- 19.1 kg versus 69.9 +/- 15 kg) in the poor-response group. All 3 cases of intraprocedural thrombosis (3.1%) were observed only in the poor-response group. CONCLUSION: We observed a high frequency of poor clopidogrel responses in the neurointerventional setting. Routine monitoring of the drug response would be helpful for the early identification of poor antiplatelet responders so that we may modify the regimen and/or treatment plan.
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dual antiplatelet therapy monitoring for neurointerventional procedures using a point of care platelet function test a single center experience
American Journal of Neuroradiology, 2008Co-Authors: Deok Hee Lee, Hashem Shaltoni, Anil Arat, J. R. Harris, Hesham Morsi, Michel E MawadAbstract:BACKGROUND AND PURPOSE: Growing evidence of the relationship between poor antiplatelet response and occurrence of clinical events elicited the need of monitoring the response which has not been part of our daily practice. We present our initial experience with a new point-of-care antiplatelet-function test (VerifyNow assay) in neurointerventional procedures. MATERIALS AND METHODS: Among the 106 consecutive patients from July 2006 to April 2007, ninety-eight met the inclusion criteria. Our preferred antiplatelet regimen was Aspirin (325 mg daily) and clopidogrel (300 mg of loading dose followed by 75 mg daily) starting 5–10 days before the procedure. The test results were reported as Aspirin-Reaction unit (ARU) for Aspirin and P2Y 12 Reaction units (PRU), baseline (BASE), and percentage inhibition for the P2Y 12 assay and were summarized as mean ± SD of the values. We analyzed the effects of several factors of poor clopidogrel response ( RESULTS: The mean ARU of Aspirin assays was 438.3 ± 47.9 (range, 350–632), and the response was poor in 2 patients (2.1%). For clopidogrel, the mean of the BASE, PRU, and percentage inhibition was 356.8 ± 56.3 (range, 234–495), 198.9 ± 104.4 (range, 8–401), and 45.2 ± 27.1% (range, 0–98), respectively. Forty-two patients (42.9%) showed poor response. Multivariate analysis showed greater body weight (81.9 Kg ± 19.1 kg versus 69.9 ± 15 kg) in the poor-response group. All 3 cases of intraprocedural thrombosis (3.1%) were observed only in the poor-response group. CONCLUSION: We observed a high frequency of poor clopidogrel responses in the neurointerventional setting. Routine monitoring of the drug response would be helpful for the early identification of poor antiplatelet responders so that we may modify the regimen and/or treatment plan.
J. R. Harris - One of the best experts on this subject based on the ideXlab platform.
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dual antiplatelet therapy monitoring for neurointerventional procedures using a point of care platelet function test a single center experience
American Journal of Neuroradiology, 2008Co-Authors: Anil Arat, Hisham Morsi, Hashem Shaltoni, J. R. Harris, Michel E MawadAbstract:BACKGROUND AND PURPOSE: Growing evidence of the relationship between poor antiplatelet response and occurrence of clinical events elicited the need of monitoring the response which has not been part of our daily practice. We present our initial experience with a new point-of-care antiplatelet-function test (VerifyNow assay) in neurointerventional procedures. MATERIALS AND METHODS: Among the 106 consecutive patients from July 2006 to April 2007, ninety-eight met the inclusion criteria. Our preferred antiplatelet regimen was Aspirin (325 mg daily) and clopidogrel (300 mg of loading dose followed by 75 mg daily) starting 5-10 days before the procedure. The test results were reported as Aspirin-Reaction unit (ARU) for Aspirin and P2Y(12) Reaction units (PRU), baseline (BASE), and percentage inhibition for the P2Y(12) assay and were summarized as mean +/- SD of the values. We analyzed the effects of several factors of poor clopidogrel response (<40% inhibition). The occurrence of thrombotic events was recorded. RESULTS: The mean ARU of Aspirin assays was 438.3 +/- 47.9 (range, 350-632), and the response was poor in 2 patients (2.1%). For clopidogrel, the mean of the BASE, PRU, and percentage inhibition was 356.8 +/- 56.3 (range, 234-495), 198.9 +/- 104.4 (range, 8-401), and 45.2 +/- 27.1% (range, 0-98), respectively. Forty-two patients (42.9%) showed poor response. Multivariate analysis showed greater body weight (81.9 Kg +/- 19.1 kg versus 69.9 +/- 15 kg) in the poor-response group. All 3 cases of intraprocedural thrombosis (3.1%) were observed only in the poor-response group. CONCLUSION: We observed a high frequency of poor clopidogrel responses in the neurointerventional setting. Routine monitoring of the drug response would be helpful for the early identification of poor antiplatelet responders so that we may modify the regimen and/or treatment plan.
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dual antiplatelet therapy monitoring for neurointerventional procedures using a point of care platelet function test a single center experience
American Journal of Neuroradiology, 2008Co-Authors: Deok Hee Lee, Hashem Shaltoni, Anil Arat, J. R. Harris, Hesham Morsi, Michel E MawadAbstract:BACKGROUND AND PURPOSE: Growing evidence of the relationship between poor antiplatelet response and occurrence of clinical events elicited the need of monitoring the response which has not been part of our daily practice. We present our initial experience with a new point-of-care antiplatelet-function test (VerifyNow assay) in neurointerventional procedures. MATERIALS AND METHODS: Among the 106 consecutive patients from July 2006 to April 2007, ninety-eight met the inclusion criteria. Our preferred antiplatelet regimen was Aspirin (325 mg daily) and clopidogrel (300 mg of loading dose followed by 75 mg daily) starting 5–10 days before the procedure. The test results were reported as Aspirin-Reaction unit (ARU) for Aspirin and P2Y 12 Reaction units (PRU), baseline (BASE), and percentage inhibition for the P2Y 12 assay and were summarized as mean ± SD of the values. We analyzed the effects of several factors of poor clopidogrel response ( RESULTS: The mean ARU of Aspirin assays was 438.3 ± 47.9 (range, 350–632), and the response was poor in 2 patients (2.1%). For clopidogrel, the mean of the BASE, PRU, and percentage inhibition was 356.8 ± 56.3 (range, 234–495), 198.9 ± 104.4 (range, 8–401), and 45.2 ± 27.1% (range, 0–98), respectively. Forty-two patients (42.9%) showed poor response. Multivariate analysis showed greater body weight (81.9 Kg ± 19.1 kg versus 69.9 ± 15 kg) in the poor-response group. All 3 cases of intraprocedural thrombosis (3.1%) were observed only in the poor-response group. CONCLUSION: We observed a high frequency of poor clopidogrel responses in the neurointerventional setting. Routine monitoring of the drug response would be helpful for the early identification of poor antiplatelet responders so that we may modify the regimen and/or treatment plan.
