Home About us Contact
|
Home About us Contact | ||
|
|
||
Antiplatelet Medication (antiplatelet + medication)
Selected AbstractsNational Study on Emergency Department Visits for Transient Ischemic Attack, 1992,2001ACADEMIC EMERGENCY MEDICINE, Issue 6 2006Jonathan A. Edlow MD Abstract Objectives: To describe the epidemiology of U.S. emergency department (ED) visits for transient ischemic attack (TIA) and to measure rates of antiplatelet medication use, neuroimaging, and hospitalization during a ten-year time period. Methods: The authors obtained data from the 1992,2001 National Hospital Ambulatory Medical Care Survey. TIA cases were identified by having ICD-9 code 435. Results: From 1992 to 2001, there were 769 cases, representing 2,969,000 ED visits for TIA. The population rate of 1.1 ED visits per 1,000 U.S. population (95% CI = 0.92 to 1.30) was stable over time. TIA was diagnosed in 0.3% of all ED visits. Physicians administered aspirin and other antiplatelet agents to a small percentage of patients, and 42% of TIA patients (95% CI = 29% to 55%) received no medications at all in the ED. Too few data points existed to measure a statistically valid trend over time. Physicians performed computed tomography scanning in 56% (95% CI = 45% to 66%) of cases and performed magnetic resonance imaging (MRI) in < 5% of cases, and there was a trend toward increased imaging over time. Admission rates did not increase during the ten-year period, with 54% (95% CI = 42% to 67%) admitted. Regional differences were noted, however, with the highest admission rate found in the Northeast (68%). Conclusions: Between 1992 and 2001, the population rate of ED visits for TIA was stable, as were admission rates (54%). Antiplatelet medications appear to be underutilized and to be discordant with published guidelines. Neuroimaging increased significantly. These findings may reflect the limited evidence base for the guidelines, educational deficits, or other barriers to guideline implementation. [source] Substantial Reduction of Platelet Adhesion by Heparin-Coated StentsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2001CHRISTOPH BICKEL M.D. Although optimized antiplatelet medication has improved the clinical outcome after coronary stenting, vessel occlusion and restenosis still remain a relevant clinical problem. Platelets play a key role in this process. Therefore, the authors compared the platelet adhesion on different stent surface modifications (electropolished without coating or coated with carbon, carbon and additional heparin, silicon carbide, or heparin alone) to investigate their role in reducing platelet adhesion. All stem and additional stainless steel plates were incubated in heparinized whole blood with radiolabeled platelets. Afrer washing the stents and plates four times, radioactivity caused by the adhesion of radiolabeled platelets was measured. The adhesion of radiolabeled platelets, compared to uncoated, electropolished stents, was reduced through silicon carbide coating to 58.6%, by carbon coating with additional heparin to 32.9%, and heparin coating alone to 7.7%. Stent coating with heparin is the most effective among the examined coatings in reducing platelet adhesion in vitro. [source] Laboratory evaluation of aspirin responsiveness,AMERICAN JOURNAL OF HEMATOLOGY, Issue 5 2010Kristi J. Smock Aspirin is the most commonly used antiplatelet medication. Laboratory monitoring of aspirin response has recently become a topic of interest due to potential impacts on patient management and clinical outcomes. This article summarizes available laboratory testing of aspirin response with focus on technical issues, limitations, and current opinion on the utility of routine patient testing. Am. J. Hematol., 2010. © 2010 Wiley-Liss, Inc. [source] Initial management of cerebrovascular disease by general practitionersBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2000R. G. J. Gibbs Background: The aim of this study was to determine the primary management of patients presenting with a new diagnosis of transient ischaemic attack (TIA) or stroke by general practitioners and to establish whether practice was uniform across the UK, and to determine whether initial management influenced the performance of carotid endarterectomy (CEA) across the health regions of the UK. Methods: Information on regional reporting of new cases of TIA and stroke between 1992 and 1996 was obtained from the General Practice Research Database, a database of six million patients from 450 practices. Analysis of data from the primary care database and routine data sources was undertaken. Main outcome measures were incidence of TIA and stroke, rates of referral for specialist opinion, prescription of antiplatelet agents and rates of CEA. Results: There were twofold differences (P < 0·00005, ,2 test) in the incidence of cerebrovascular disease between Regional Health Authorities (RHAs) between the years 1992 and 1996 and also for each year. Mean stroke incidence per annum was 143 per 100 000 and TIA incidence 183 per 100 000. Yorkshire had the highest incidence at 170 (stroke) and 206 (TIA) per 100 000 of the population compared with 95 and 98 per 100 000 for Oxford. Some 37 per cent of new patients with stroke and 19 per cent of patients with TIA were referred for specialist opinion following initial diagnosis. These rates did not change over time. There was no positive correlation between disease incidence and referral rate; Yorkshire referred the least (14 per cent) and Oxford the most (26 per cent). The majority of referrals for TIA were made to general medicine (39 per cent); 6 per cent of patients were referred directly for surgical opinion. Mean prescription rate of antiplatelet medication over the time period was 17 per cent for patients with stroke and 35 per cent for those with TIA. Mean CEA rate for English RHAs for the time interval was 15·5 per 100 000. There was a positive correlation between the incidence of disease and rate of CEA, with the regions with the highest incidence of disease tending to perform the most CEAs. Conclusion: The incidence of cerebrovascular disease varies significantly across health regions in the UK. There was no correlation between the regional incidence of disease and the number of patients referred for specialist opinion, but CEA rates were generally correlated with the regional difference in incidence of disease. The low referral rate may be a factor in the perceived underperformance of CEA in the UK and the low usage of antiplatelet medication is surprising. © 2000 British Journal of Surgery Society Ltd [source] Antiplatelet Therapy in Cerebrovascular Disease: Implications of MATCH and CHARISMA Results for CardiologistsCLINICAL CARDIOLOGY, Issue 12 2007Dan James Fintel M.D. Abstract Cardiovascular disease is prevalent among patients with stroke; thus, cardiologists frequently treat patients at high risk for stroke. Results from recent clinical trials of antiplatelet medications, given alone or in combination, may be of special interest to cardiologists. The MATCH study demonstrated no significant difference between clopidogrel alone and clopidogrel plus aspirin in reducing risk of vascular events after stroke or transient ischemic attack. A 1.3% increased risk of major bleeding was associated with clopidogrel plus aspirin. In CHARISMA, clopidogrel plus aspirin did not reach statistical significance vs. placebo plus aspirin in reducing incidence of myocardial infarction (MI), stroke, or death from cardiovascular causes in patients with stable atherothrombotic disease; clopidogrel was associated with an increase in moderate bleeding. These results suggest that clopidogrel plus aspirin may be inappropriate as first-line therapy for secondary stroke prevention. In patients with established cardiovascular disease at risk for MI or other vascular events, physicians must weigh the benefits and risks before choosing this therapy. Selection of an antiplatelet agent must be based on patient history, including previous MI and stroke, susceptibility to bleeding, and other high-risk factors (e.g. advanced age and diabetes). Aspirin plus extended-release dipyridamole may be more effective than clopidogrel for preventing stroke in high-risk patients. This article strives to put MATCH and CHARISMA results into context by providing an overview of antiplatelet therapy, including relevant clinical trial results, a review of current practice guidelines, and a summary of an ongoing study that will improve clinical decision making. Copyright © 2007 Wiley Periodicals, Inc. [source] | ||||||||||