Antiplatelet drugs in cardiovascular prevention: coronary events and stroke: primary prevention

(1) Aspirin reduces the risk of myocardial infarction in men over 40 with no history of cardiovascular disease, and in hypertensive patients of both sexes over that age. But it does not seem to reduce overall mortality, and its risk-benefit ratio is not very favourable because of its gastrointestinal adverse effects. (2) In patients with symptomatic lower-limb arterial disease, ticlopidine and clopidogrel reduce the risk of coronary events.     

Antiplatelet drugs in cardiovascular prevention: stroke: acute phase and secondary prevention

(1) In the acute phase of ischaemic stroke in patients free of thrombogenic heart disease, combined treatment with aspirin + moderate-dose unfractionated heparin reduces the risk of relapse and death. Unfractionated heparin at higher anticoagulant doses has an unfavourable risk-benefit ratio. Treatment is controversial in patients with events associated with atrial fibrillation. (2) After ischaemic stroke in patients free of thrombogenic heart disease, aspirin reduces the risk of relapse and death. Other antiplatelet drugs, the aspirin + dipyridamole combination, ticlopidine and clopidogrel have similar efficacy to aspirin. (3) The risk-benefit ratio of oral anticoagulant is favourable after ischaemic stroke associated with atrial fibrillation; but it is unfavourable after stroke without thrombogenic heart disease.     

Antiplatelet drugs in cardiovascular prevention: coronary events: acute phase and secondary prevention

(1) Aspirin reduces acute-phase mortality after myocardial infarction, and also reduces the risk of myocardial infarction and death in patients with unstable angina. Aspirin reduces the risk of myocardial infarction in patients with stable angina and after unstable angina, and the risk of relapse after myocardial infarction. It reduces the risk of complications during coronary angioplasty, and the risk of venous coronary bypass graft occlusion after coronary surgery. (2) The best risk-benefit ratio with aspirin is achieved at a daily dose of 75-350 mg; 160 mg/day is the best-validated dose in the acute phase of myocardial infarction. (3) Aspirin must be combined with a thrombolytic agent in patients with myocardial infarction, and with heparin in patients with unstable angina. During coronary stenting the aspirin + clopidogrel combination may have a better risk-benefit ratio than the aspirin + ticlopidine combination. (4) Clopidogrel can be used when aspirin is contraindicated or poorly tolerated. (5) Oral anticoagulants seem a better option than aspirin after complicated myocardial infarction.     

Antiplatelet drugs in cardiovascular prevention: take adverse effects and costs into account

(1) Several antiplatelet drugs have proven preventive efficacy, including aspirin, aspirin + dipyridamole, clopidogrel, ticlopidine and flurbiprofen. They differ mainly in their adverse effects and costs. (2) Aspirin has essentially gastrointestinal adverse effects, whose incidence can be limited by prescribing a daily dose below 350 mg. (3) The addition of dipyridamole to aspirin can cause headache and diarrhoea. (4) Ticlopidine should be avoided because of the risk of agranulocytosis. (5) Adverse effects are less frequent and less severe with clopidogrel than with ticlopidine. (6) Like other nonsteroidal antiinflammatory drugs, flurbiprofen has mainly gastrointestinal adverse effects. (7) Treatment is least costly with low-dose aspirin and most costly with clopidogrel.     

Antiplatelet therapy in secondary stroke prevention

Stroke is the third leading cause of death in the United States. Antiplatelet agents are the mainstays of ischaemic stroke prevention. The therapies recommended for initial therapy include aspirin (50 - 325 mg) daily, the combination of aspirin (25 mg) and extended-release dipyridamole (200 mg) b.i.d., or clopidogrel (75 mg) daily. Ticlopidine 250 mg b.i.d. is approved for stroke prevention but is no longer a first-line therapy. This article reviews the literature on antiplatelet agents for secondary stroke prevention.     

Antiplatelet therapy in secondary stroke prevention

Stroke is the third leading cause of death in the United States. Antiplatelet agents are the mainstays of ischaemic stroke prevention. The therapies recommended for initial therapy include aspirin (50 - 325 mg) daily, the combination of aspirin (25 mg) and extended-release dipyridamole (200 mg) b.i.d., or clopidogrel (75 mg) daily. Ticlopidine 250 mg b.i.d. is approved for stroke prevention but is no longer a first-line therapy. This article reviews the literature on antiplatelet agents for secondary stroke prevention.     

抗血小板治疗在缺血性脑卒中预防中的应用

抗血小板治疗是缺血性脑卒中(IS)一级和二级预防的重要组成部分,未接受溶栓治疗的急性IS患者应尽早开始阿司匹林治疗.噻吩吡啶类药物及血小板糖蛋白Ⅱ b/Ⅲ a受体抑制剂等单药用于急性IS治疗的安全性和有效性目前尚缺乏足够证据,抗血小板药物联合应用的疗效和可能的风险尚需进一步研究.对无法采用华法林治疗的高危房颤患者,阿司匹林或阿司匹林+氯吡格雷双联治疗是当前比较推崇的补充选择手段.     

Antiplatelet medication management in patients hospitalized with ischemic stroke.

PURPOSE: The use of antiplatelet agents in patients hospitalized with ischemic stroke was studied. METHODS: Patients with a primary or secondary diagnosis of noncardiogenic, thrombotic ischemic stroke from January 2002 through December 2004 were included in the analysis. Patients were then subdivided into four treatment groups and one no-treatment group based on whether they were charged for any of four antiplatelet regimens (low-dose aspirin [=325 mg daily], extended-release dipyridamole 200 mg with aspirin 25 mg, clopidogrel 75 mg, and clopidogrel 75 mg [as the bisulfate] plus low-dose aspirin) at any time during hospitalization. Patients who did not receive any of these medications during hospitalization were defined as the no-treatment group. A patient's illness severity was measured and compared with other patients in the data set. RESULTS: A total of 44,108 patients were assigned to the treatment group, and 14,255 patients were assigned to the no-treatment group. In general, longer lengths of stay and higher institutional costs were associated with the no-treatment group. Patients in the no-treatment group consistently displayed more comorbid conditions than did patients in the treatment group. The no-treatment group exhibited higher usage rates of both fibrinolytic agents and vitamin K. More patients in the treatment group were discharged to home or rehabilitation, while more patients in the no-treatment group were either discharged to another nursing facility or died before discharge. CONCLUSION: A retrospective analysis of a large national hospital database revealed that one quarter of patients who suffered an acute stroke did not receive antiplatelet drugs during their patient stay. Outcomes for such patients were poorer than for patients who had received antiplatelet therapy.     

Lipid lowering therapy as an important adjunct to stroke prevention in coronary heart disease patients

Lipid altering pharmacotherapy has been shown to reduce stroke in coronary heart disease (CHD) patients. Several mechanisms of cerebrovascular protection attributed to these agents include reduction in embolic stroke from cardiac, aortic and carotid sites, delayed progression of carotid stenoses, stabilization of vulnerable carotid atherosclerotic plaque and improvement in cerebral blood flow. (c) 2001 Prous Science. All rights reserved.     

Primary and secondary stroke prevention with antiplatelet drugs

Aspirin is not effective in the primary prevention of stroke. Patients with TIA or ischemic stroke carry a risk of recurrent stroke between 5 and 20% per year. In patients with TIA or ischemic stroke of noncardiac origin antiplatelet drugs are able to decrease the risk of stroke by 11-15% and the risk of stroke, MI and vascular death by 15-22%. Aspirin is the most widely used drug. It is affordable and effective. Low doses of 50-325 mg aspirin are as effective as high doses and cause less gastrointestinal side effects. Severe bleeding complications are dose-dependent. The combination of aspirin with slow release dipyridamole is superior to aspirin alone for stroke prevention. Clopidgrel is superior to aspirin in patients at high risk of recurrence. The combination of aspirin plus clopidogrel is not more effective than clopidogrel alone but carries a higher bleeding risk. None of the antiplatelet agents is able to reduce mortality.     

Antiplatelet and antileukocyte effects of cardiovascular, immunomodulatory and chemotherapeutic drugs

In vitro and ex vivo interactions of betaadrenoceptor blocking drugs, antihistamines and chloroquine with blood platelets and polymorphonuclear leukocytes resulted in different alterations of regulatory functions of these blood cells. Inhibition of platelet aggregation, arachidonate regulatory pathway, 5-hydroxytryptamine transportation, removal of platelet membrane receptors, inhibition of second messenger pathways at subcellular level and suppression of phagocytosis are indicative of nonreceptor rather than specific receptor interactions. Binding of drugs with biomembranes is reversible depending on the ionic charge of the molecule and hydrophobicity of the bilayer, partition coefficient, pH and pKa of the amphiphilic molecules and other physico-chemical properties of amphiphilic drugs. Alterations in the drug molecule structure alters the drug-phospholipid binding profile. Any change in the metabolism of membrane phospholipids directly or indirectly influences one or more of the important components of the phospholipid-signalling pathway. In addition to changes in phospholipase A, C and D activities, protein kinase C, calmodulin-phosphodiesterase, Ca2+,Mg2+-ATPase, Na+,K+-ATPase and other messengers were found to be changed in cells and tissue after cationic amphiphilic drug (CAD) administration. Although not much has been understood of the mechanism by which some CAD affect immune functions, there are good reasons to suggest that these effects might occur. CADs share sufficient similarities in their structure even though they come from diverse pharmacological classes. CADs affect ion transport, immune functions, tumour growth, serotonin metabolism and several other functions in the body. Extensive therapeutic use and associated side effects have generated a great deal of interest in understanding the nonreceptor interactions with CADs.     

New anti-thrombotic drugs for stroke prevention

Ischemic stroke is the third most common cause of death and of long-term disability and exhibits a high recurrence rate. Therefore, appropriate primary and secondary prevention is mandatory. In non-cardioembolic stroke, in addition to lifestyle changes and to targeted treatments, current guidelines recommend antiplatelet treatment. In cardioembolic stroke, Vitamin K antagonists (VKAs) are recommended. Although a favorable risk/benefit ratio of both treatments has also been demonstrated in elderly patients, registry data emphasize that such interventions are often under-used, especially in patients with atrial fibrillation (AF). Furthermore, variability in the inter-individual response to drugs has been recognized as a leading cause of event recurrence. Thus, in addition to poor adherence, efficacy and safety issues appear to be involved in the recurrence rate of stroke. In this review, we report main Registries data on adherence to stroke prevention treatment schedule. We also discuss the major limitations of "traditional" antithrombotic drugs and report Phase III study results on safety and efficacy of new antiplatelet and anticoagulant drugs, with emphasis on stroke prevention.     

阿托伐他汀钙片联合心血管药物对冠心病患者血脂联素及脂代谢异常的影响

目的探讨阿托伐他汀钙片联合心血管药物对冠心病患者血脂联素(APN)及脂代谢异常的影响。方法选取2016年1月至2017年3月我院收治的冠心病患者300例,应用数字表法将患者随机分为2组,对照组应用辛伐他汀片治疗,观察组应用阿托伐他汀钙片联合辛伐他汀片治疗。比较两组患者肿瘤坏死因子-α(TNF-α)、IL(白细胞介素)-6、IL-8、超敏C反应蛋白(hs-CRP)炎性因子浓度、APN、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、总胆固醇(TC)水平,肱动脉内径变化、颈动脉内膜中层厚度、颈动脉斑块发生率,分析引发冠心病的危险因素。结果观察组TNF-α、IL-6、IL-8、hs-CRP炎性因子浓度低于对照组(P<0.05),APN、LDL-C水平高于对照组(P<0.05),HDL-C、TG、TC水平低于对照组(P<0.05),肱动脉内径变化、颈动脉内膜中层厚度小于对照组(P<0.05),颈动脉斑块发生率低于对照组(P<0.05)。TC、血糖(FBG)是引发冠心病的高危因素,APN是冠心病的保护因素。结论阿托伐他汀钙片联合辛伐他汀片治疗冠心病,可以提高患者的APN水平,改善脂代谢异常情况。     

阿托伐他汀钙片联合心血管药物治疗冠心病分析

目的对冠心病患者予以阿托伐他汀钙片联合心血管药物治疗,以此分析阿托伐他汀钙片联合心血管药物治疗的临床效果。方法选取冠心病患者共计100例,选取2016年3月～2017年3月,随机分组,并行不同的治疗方式:常规心血管药物治疗、阿托伐他汀钙片联合心血管药物治疗,对应组别:对照组、研究组。经SPSS21.0系统分析和对比组间的临床治疗总有效率、TC、TG、LCL‐C、HDL-C水平指标。结果研究组的临床治疗总有效率(96.00%)、HDL-C(1.57±0.15)mmol/L水平指标均高于对照组临床治疗总有效率(76.00%)、HDL-C(1.26±0.36)mmol/L,且研究组的TC(5.14±0.44)mmol/L、TG(1.43±0.66)mmol/L、LCL-C(3.36±0.33)mmol/L水平指标均低于对照组,差异有统计学意义(P 0.05)。结论阿托伐他汀钙片联合心血管药物治疗冠心病的临床价值十分显著,能够有效改善患者的血脂水平和提高其临床治疗效果。     

他汀类联合心血管药物在冠心病治疗中的应用价值

目的探讨分析他汀类联合心血管药物在冠心病治疗中的应用价值。方法本研究选取2013年2月~2016年1月我院收治的110例冠心病患者作为研究对象,随机分为观察组和对照组,各55例;对照组给予常规心血管类药物进行治疗,观察组在对照组基础上加用他汀类药物进行治疗,两组患者均治疗2个月;治疗前后对两组患者血脂四项水平及治疗效果进行对比分析。结果经治疗后两组患者显效率和有效率比较均无显著差异(P均0.05),但观察组治疗总有效率显著高于对照组(96.36%vs 74.55%,P0.05);与治疗前相比,经治疗后两组患者血脂四项水平均得到显著改善(P均0.05),且观察组改善情况显著优于对照组(P均0.05)。结论他汀类联合心血管药物用于冠心病患者的治疗可显著提高治疗效果并改善患者血脂四项水平,值得临床推广应用。     

Pharmaceutical thrombosis prevention in cardiovascular disease

Cardiovascular diseases are a leading cause of morbidity and mortality in modern society. As a result of this, great efforts have been made to establish regimens for prophylaxis and treatment of such disorders. Pharmacological intervention is also a prerequisite for the success of other therapeutic approaches, e.g. coronary angioplasty. Prevention of platelet aggregation is a goal that can be achieved by counteracting various receptors on the platelet surface. The main attentions for such interventions are focused on inhibiting the glycoprotein IIb/IIIa receptor. So far, they are limited to intravenous usage. Adenosine diphosphate receptor inhibitors are available for intravenous and oral usage. Their effect is, at least partly, also exerted via the counteraction of adenosine diphosphate-mediated activation of the glycoprotein IIb/IIIa complex. An oral direct thrombin inhibitor is under clinical evaluation. This review focuses on atherothrombotic disorders, but recent advances within new fields of anticoagulation (i.e. treatment of severe septic shock and a novel approach to prevent thromboembolic disorder during surgery) should not be overlooked.