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Optimization of antiplatelet/antithrombotic therapy for secondary stroke prevention
Srivastava Padma
Annals of Indian Academy of Neurology , 2010,
Abstract: Role of antiplatelet therapy in secondary stroke prevention is of major significance. Antiplatelet agents predominantly in use are aspirin, clopidogrel, and combination regimes. The review focuses on the optimization of antiplatelet regimen based on evidence obtained from randomized-controlled trials, on different antiplatelet regimes and the risk assessment that may be unique to each patient.
Vision loss following snakebite in a patient with controlled aplastic anemia
Kweon, EY;Lee, DW;Ahn, M;Nork, TM;Cho, NC;
Journal of Venomous Animals and Toxins including Tropical Diseases , 2009, DOI: 10.1590/S1678-91992009000100015
Abstract: viper venoms act mainly on blood and blood vessels. reports of ophthalmic manifestations after snakebite include ptosis and ophthalmoplegia. in the current study, we describe a case that developed bilateral retinal and subretinal hemorrhage following snakebite. bilateral retinal hemorrhage is a rare ocular complication of snake envenomation and has not been reported with fundus photographs in the literature so far.
Posterior fossa infarct following Viper bite: a paradox
Deepu, D;Hrishikesh, S;Suma, MT;Zoya, V;
Journal of Venomous Animals and Toxins including Tropical Diseases , 2011, DOI: 10.1590/S1678-91992011000300017
Abstract: cerebral infarction after a viper bite is relatively uncommon. a combination of factors has been implicated in the pathophysiology of infarct following snakebite. in this case report, the clinical outcome after a posterior circulation infarct and various possibilities that could lead to such a catastrophic event are discussed. the present study stresses the need to keep hydration, blood pressure and central venous pressure optimal in all snakebite patients. cerebral infarction should be considered a differential diagnosis, in any patient with neurological deterioration following snakebite. prognosis of such patients with posterior circulation stroke remains poor and decompressive craniectomy has not been found to be helpful.
The role of modern antiplatelet therapy in prevention of atherothrombosis: the importance of clopidogrel and its generic drugs  [cached]
O.V. Gaisenok
Rational Pharmacotherapy in Cardiology , 2011,
Abstract: Current issues of atherothrombosis prevention and treatment optimization with antiplatelet therapy in patients with cardioascular diseases are discussed. Role of clopidogrel in contemporary antiplatelet therapy is focused on, especially in the aspect of the problem of aspirin resistance. Chronology of the clopidogrel generics appearance and prospects of their use is presented.
Antiplatelet combinations for prevention of atherothrombotic events  [cached]
Mario Bollati,Fiorenzo Gaita,Matteo Anselmino
Vascular Health and Risk Management , 2011,
Abstract: Mario Bollat,i Fiorenzo Gaita, Matteo AnselminoDepartment of Internal Medicine, Division of Cardiology, University of Torino, ItalyAbstract: Antiplatelet therapy plays a fundamental role in reducing atherothrombotic events by several pathways. The present work reviews available evidence on antiplatelet therapy both for primary prevention and in the presence of established peripheral, cerebral, or cardiac ischemic disease. Due to the importance of adherence to therapy to achieve optimal effects, special attention is given to the use of fixed-dose oral formulations in the clinical subset of patients in whom double antiplatelet therapy has proven indications.Keywords: aspirin, clopidogrel, ticlopidine, fixed-dose combinations
Antiplatelet Resistance and Thromboembolic Complications in Neurointerventional Procedures  [PDF]
Thomas J. Oxley,Peter J. Mitchell,Stephen Davis
Frontiers in Neurology , 2011, DOI: 10.3389/fneur.2011.00083
Abstract: Antiplatelet resistance is emerging as a significant factor in effective secondary stroke prevention. Prevalence of aspirin and clopidogrel resistance is dependent upon laboratory test and remains contentious. Large studies in cardiovascular disease populations have demonstrated worse ischemic outcomes in patients with antiplatelet resistance, particularly in patients with coronary stents. Thromboembolism is a complication of neurointerventional procedures that leads to stroke. Stroke rates related to aneurysm coiling range from 2 to 10% and may be higher when considering silent ischemia. Stroke associated with carotid stenting is a major cause of morbidity. Antiplatelet use in the periprocedure setting varies among different centers. No guidelines exist for use of antiplatelet regimens in neurointerventional procedures. Incidence of stroke in patients post procedure may be partly explained by resistance to antiplatelet agents. Further research is required to establish the incidence of stroke in patients with antiplatelet resistance undergoing neurointerventional procedures.
Secondary Stroke Prevention, and the Role of Antiplatelet Therapies
Howard S. Kirshner
Clinical Medicine : Therapeutics , 2009,
Abstract: This review considers treatments of proved efficacy in secondary stroke prevention, with an emphasis on antiplatelet therapy. Most strokes could be prevented, if readily available lifestyle and risk factor modifications could be applied to everyone. In secondary stroke prevention, the same lifestyle and risk factor modifications are also important, along with anticoagulation for patients with cardiac sources of embolus, carotid procedures for patients with significant internal carotid artery stenosis, and antiplatelet therapy. For patients with noncardioembolic ischemic strokes, FDA-approved antiplatelet agents are recommended and preferred over anticoagulants. ASA, clopidogrel, and ASA + ER-DP are recognized as accepted first-line options for secondary prevention of noncardioembolic ischemic stroke. Combined antiplatelet therapy with ASA + clopidogrel has not been shown to carry benefit greater than risk in stroke or TIA patients. Aspirin and extended release dipyridamole appeared to carry a greater benefit over aspirin alone in individual studies, leading to a recommendation of this agent in the AHA guidelines, but the recently completed PRoFESS trial showed no difference in efficacy between clopidogrel and aspirin with extended release dipyridamole, and clopidogrel had better tolerability and reduced bleeding risk.
Advances in antiplatelet technologies to improve cardiovascular disease morbidity and mortality: a review of ticagrelor  [cached]
Davis EM,Knezevich JT,Teply RM
Clinical Pharmacology: Advances and Applications , 2013,
Abstract: Estella M Davis, Jon T Knezevich, Robyn M Teply Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA Abstract: Antiplatelet therapy is widely used with proven benefit for the prevention of further ischemic cardiac complications in patients with acute coronary syndrome. Treatment guidelines for acute coronary syndrome and percutaneous coronary intervention now recommend the use of oral antiplatelet agents including ticagrelor, prasugrel, or clopidogrel in combination with aspirin to comprise dual antiplatelet therapy for the prevention of recurrent ischemic events. The limitations of conventional antiplatelet therapy with clopidogrel or prasugrel include the potential for low response to clopidogrel identified through platelet reactivity or genetic testing, increased risk of bleeding with prasugrel, or slower return to normal platelet activity in patients who received either prasugrel or clopidogrel prior to emergent or planned surgical procedures. This review will discuss the pharmacokinetic and pharmacodynamic properties of ticagrelor in comparison to conventional P2Y12 receptor inhibitors and its utility in patients identified as low responders to clopidogrel. Completed clinical studies and substudies comparing ticagrelor to clopidogrel and ongoing clinical trials evaluating ticagrelor in acute coronary syndrome patients will also be reviewed. Keywords: ticagrelor, antiplatelet, acute coronary syndrome, ST elevation myocardial infarction, non-ST elevation MI, percutaneous coronary intervention
The Use of Ecological Niche Modeling to Infer Potential Risk Areas of Snakebite in the Mexican State of Veracruz  [PDF]
Carlos Ya?ez-Arenas, A. Townsend Peterson, Pierre Mokondoko, Octavio Rojas-Soto, Enrique Martínez-Meyer
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0100957
Abstract: Background Many authors have claimed that snakebite risk is associated with human population density, human activities, and snake behavior. Here we analyzed whether environmental suitability of vipers can be used as an indicator of snakebite risk. We tested several hypotheses to explain snakebite incidence, through the construction of models incorporating both environmental suitability and socioeconomic variables in Veracruz, Mexico. Methodology/Principal Findings Ecological niche modeling (ENM) was used to estimate potential geographic and ecological distributions of nine viper species' in Veracruz. We calculated the distance to the species' niche centroid (DNC); this distance may be associated with a prediction of abundance. We found significant inverse relationships between snakebites and DNCs of common vipers (Crotalus simus and Bothrops asper), explaining respectively 15% and almost 35% of variation in snakebite incidence. Additionally, DNCs for these two vipers, in combination with marginalization of human populations, accounted for 76% of variation in incidence. Conclusions/Significance Our results suggest that niche modeling and niche-centroid distance approaches can be used to mapping distributions of environmental suitability for venomous snakes; combining this ecological information with socioeconomic factors may help with inferring potential risk areas for snakebites, since hospital data are often biased (especially when incidences are low).
Stroke and snakebite: case report
Santos-Soares, Paulo César;Bacellar, Aroldo;Povoas, Heitor Portella;Brito, Alex Ferreira;Santana, Diana Lara Pinto;
Arquivos de Neuro-Psiquiatria , 2007, DOI: 10.1590/S0004-282X2007000200030
Abstract: snakebites are common and lead to potential complications like neuromyopathies and strokes, these last associated with disturbances of blood coagulation. we report on a 65 years old woman of cerebral intraparenchymal hemorrhage associated with snakebite by a bothrops jararaca that occurred in the reconcavo of bahia, ba, brazil. the patient was submitted to a surgical evacuation of the hematoma, with a good result. this report is accompanied by a revision about the association among snakebite and neurological complications, emphasizing strokes. statistics reveal a hight incidence of snakebite in the world, mainly in tropical countries and gets attention for his socioeconomic impact. the clinical and laboratorial characteristics to identify the victims that present a high risk of presenting strokes are discussed in order to identify early those patients, so that they may be treated in a more precocious and effective way.
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