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Yildiz M.,Istanbul University | Yildiz B.S.,Dr Lutfi Kirdar Kartal Educational and Research Hospital | Aydin E.,Kartal Kosuyolu Yuksek Ihtisas Educational and Research Hospital | Akin I.,University of Mannheim
Cardiovascular and Hematological Disorders - Drug Targets | Year: 2014

Stent thrombosis is a serious complication in stent era. It can be presented as death, cardiogenic shock or a large non-fatal myocardial infarction, usually with ST elevation. Risks of stent thrombosis, stent thrombosis incidence and predictors are controversial issues due to sparse and controversial data. But all attending physicians should have knowledge of the risk of stent thrombosis, predisposing and protective factors before and after the intervention. This issue is discussed in detail in this review. © 2014 Bentham Science Publishers. Source


Yildiz B.S.,Dr Lutfi Kirdar Kartal Educational and Research Hospital | Yildiz M.,Istanbul University | Akin I.,University of Mannheim
Cardiovascular and Hematological Disorders - Drug Targets | Year: 2014

Adenosin diphospat (ADP) plays a crucial role in thrombus formation. Therefore its inhibition can control excess platelet generation to prevent cardiovascular events in patients with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). One of ADP’s target receptors, P2Y12 has a limited tissue distribution and is therefore an attractive pharmacological target. Thienopyridines are class of drugs that specifically and irreversibly inhibit the P2Y12 receptor. Three generations exist and in most patients, they are administered in combination with aspirin. Because of possible gastro-intestinal toxicity, a proton pump inhibitor (PPI) is often concomitantly prescribed. However, several studies suspect an interaction between thienopyridines (in particular with clopidogrel) and PPIs which decreases the inhibition of platelet formation and thus enhances the risk for cardiac events. In this review, a concise overview of pharmacokinetic and pharmacodynamic properties of all thienopyridines is given and a critical discussion of the presumed interaction with PPIs is provided. © 2014 Bentham Science Publishers. Source


Yildiz B.S.,Dr Lutfi Kirdar Kartal Educational and Research Hospital | Yildiz M.,Istanbul University | Aydin E.,Kartal Kosuyolu Yuksek Ihtisas Educational and Research Hospital | Akin I.,University of Mannheim
Cardiovascular and Hematological Disorders - Drug Targets | Year: 2014

In case of coronary stenting in patients taking long-term oral anticoagulants (OAC), addition of both aspirin and clopidogrel in the drug regimen (so-called triple antiplatelet therapy) is recommended. However such triple therapy increases the risk of serious bleeding events. Comparative data on the efficacy and safety of the triple therapy versus therapy with a single antiplatelet agent and oral anticoagulants in case of coronary stenting are very rare. Most studies show a decreased stroke and myocardial infarction risk, but an increased risk of bleeding events in case of triple therapy. There is general agreement that, when possible, the duration of triple therapy should be shortened followed by clopidogrel and an oral anticoagulant to minimize bleeding risk without increasing other adverse events. In patients with a high risk of bleeding, BMS should be used and triple therapy should be applied for only 1month, followed by one antiplatelet agent and oral anticoagulant. The WOEST study was the first study showing that therapy with clopidogrel and OAC is safe and reduces bleeding and mortality more effectively than triple therapy including aspirin in patients undergoing coronary stenting. Although the risk of bleeding increases with triple therapy as compared to OAC plus a single antiplatelet agent, the second treatment regimen cannot be recommended to all patients. However for those at the highest risk of bleeding it is not unreasonable to consider. Additional randomized studies are needed for the implementation of future treatment guidelines in patients with high risk for bleeding and thrombotic complications. © 2014 Bentham Science Publishers. Source


Yildiz M.,Istanbul University | Yildiz B.S.,Dr Lutfi Kirdar Kartal Educational and Research Hospital | Gursoy M.O.,Gazi Emir Nevvar Salih Isgoren State Hospital | Akin I.,University of Mannheim
Cardiovascular and Hematological Disorders - Drug Targets | Year: 2014

The interventional treatment of coronary artery disease was introduced in 1970's by Andreas Grüntzig. The initial treatment strategy with plain old balloon angioplasty (POBA) was associated with high restenosis rates. The introduction of coronary stents, especially drug-eluting stents (DES) in 2002 has improved the results by lowering the rate of in-stent restenosis from 20-40% in the era of bare-metal stent (BMS) to 6-8%. However, in 2006 with the observation of late stent thrombosis the reputations of DES have decreased. However, improvements in stent design especially antiproliferative agents, polymeric agents as well as stent platforms improved newer generation DES. In controlled trials as well as registries the use of second-generation DES as compared to bare-metal stents (BMS) was associated with better clinical and angiographic results. A further development of these stents with use of biodegradable polymers, polymer-free stents, and biodegradable stents on the basis of poly L-lactide (PLLA) or magnesium resulted in third-generation DES and has been evaluated in preclinical and first clinical trials. However, to date, there is a lack of data comparing these thirdgeneration DES with first- and second-generatrion DES in a large scale. © 2014 Bentham Science Publishers. Source


Yildiz M.,Istanbul University | Yildiz B.S.,Dr Lutfi Kirdar Kartal Educational and Research Hospital | Gursoy M.O.,Gazi Emir Nevvar Salih Isgoren State Hospital | Akin I.,University of Mannheim
Cardiovascular and Hematological Disorders - Drug Targets | Year: 2014

Antiplatelet therapy plays an important role in the treatment of patients suffering from acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) in order to prevent atherothrombotic events and restenosis or ischemic reocclusion, respectively. Moreover, stent implantation is often performed along with PCI to ensure that the arteries remain open. However, stent thrombosis ST is a possible complication which can occur up to about one year after the procedure. Therefore, it is standard to treat patients with a dual antiplatelet regime whereby aspirin is combined with either clopidogrel, prasugrel or ticagrelor. This review summarizes the characteristics of these P2Y12 antagonists and evaluates the current and future clinical guidelines for antiplatelet therapy in the setting of PCI with or without stenting. © 2014 Bentham Science Publishers. Source

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