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Huber K.,Cardiology and Emergency Medicine
Advances in Cardiology | Year: 2012

For many years clopidogrel was the 'gold standard' ADP receptor antagonist in patients with coronary artery disease in combination with acetylsalicylic acid, i.e. in elective/stable patients after coronary stent implantation and in patients with acute coronary syndromes with/without percutaneous coronary intervention. For the latter group, in which the risk of atherothrombotic events is increased, the new ADP receptor-antagonists, e.g. prasugrel and ticagrelor, have shown their superiority over clopidogrel. This is mainly based on the fact that up to 30% of patients with acute coronary syndromes tend to be low- or non-responders to therapy due to non-genetic and/or genetic causes. Nevertheless, there is still room for the use of clopidogrel in the majority of patients with coronary artery disease. This review summarizes the latest knowledge of clopidogrel and its current indications. Copyright © 2012 S. Karger AG, Basel.

Huber K.,Cardiology and Emergency Medicine | Hamad B.,IMS Health
Nature Reviews Drug Discovery | Year: 2011

Ticagrelor (Brilique; AstraZeneca), an oral antiplatelet therapy, was granted marketing authorization by the European Commission in December 2010 for the prevention of atherothrombotic events in adult patients with acute coronary syndromes. © 2011 Macmillan Publishers Limited. All rights reserved.

Halvorsen S.,University of Oslo | Huber K.,Cardiology and Emergency Medicine
Hamostaseologie | Year: 2014

Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI), as long as it can be delivered within 90-120 minutes from patient's first medical contact, and is the leading reperfusion strategy in most European countries. However, as PPCI cannot be offered in a timely manner to all patients, fibrinolytic therapy (FT) is the recommended choice in patients with an anticipated delay to PPCI of >90-120 minutes, presenting early after symptom onset and without contra-indications. FT should preferably be started in the pre-hospital setting. Following FT, all patients should be transferred to a PCI-center for rescue PCI or routine coronary angiography with PCI as indicated. Such a pharmaco-invasive strategy, combining FT with invasive treatment, has recently been shown to be non-inferior to PPCI in patients living in areas with long transfer delays to PCI (>60 minutes). In this overview, we will briefly present the evidence for the benefit of FT in STEMI, and discuss the role of FT in the current era of PPCI as well as the optimal treatment following pharmacologic reperfusion. © Schattauer 2014.

There remains uncertainty over optimal antithrombotic management strategy for patients with atrial fibrillation (AF) presenting with an acute coronary syndrome and/or undergoing percutaneous coronary intervention/stenting. Clinicians need to balance the risk of stroke and thromboembolism against the risk of recurrent cardiac ischaemia and/or stent thrombosis and the risk of bleeding. The full consensus document comprehensively reviews the published evidence and presents a consensus statement on a 'best practice' antithrombotic therapy guideline for the management of antithrombotic therapy in such AF patients. This executive summary highlights the main recommendations from the consensus document. © The Author 2010.

Huber K.,Cardiology and Emergency Medicine
European Heart Journal | Year: 2010

In their manuscript Harmsze et al.4 concluded that personalized therapy targeting patients who carry these genetic variants might help to improve clinical outcome after stent implantation. For the clinical role of genetic profiling multiple unknown factors still remain: while in the majority of trials CYP2C19 genetic polymorphisms and occasionally CYP2C9 genetic polymorphisms have been shown to reduce clopidogrel metabolism and its clinical effectiveness, there are no prospective studies demonstrating a clinical benefit of personalizing antiplatelet therapy based on genotyping. Commercially available genetic tests that can determine CYP2C19 genotype (and other) variants are not routinely reimbursed and point of care assays (e.g. for patients with ACS) are lacking at present. Moreover, it is important to point out that CYP2C19 polymorphisms account for only ∼12% of variability in clopidogrel platelet response,15 the positive predictive value of CYP2C19 loss-of-function polymorphisms for cardiovascular events in patients with ACS undergoing PCI is low, ∼12- 20%,8,15 and other clinical factors and risk constellations might be of greater clinical importance. Finally, it is not known whether a specific genetic polymorphism is capable of influencing outcome for the individual patient. Accordingly, genetic profiling should not be recommended for routine use at present but will remain of increased scientific interest. © 2010 The Author.

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