9/8/2023 0 Comments Antiplatelet medicationKulcsár Z, Houdart E, Bonafé A, Parker G, Millar J, Goddard AJ, et al. Very late thrombosis of flow-diverting constructs after the treatment of large fusiform posterior circulation aneurysms. Klisch J, Turk A, Turner R, Woo H, Fiorella D. Abciximab is a safe rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization: single center experience in 42 cases and review of the literature. Ries T, Siemonsen S, Grzyska U, Zeumer H, Fiehler J. Effect of antiplatelet therapy on thromboembolic complications of elective coil embolization of cerebral aneurysms. Yamada NK, Cross DT 3rd, Pilgram TK, Moran CJ, Derdeyn CP, Dacey RG Jr. A systematic review and meta-analysis of observational evidence for the use of bailout self-expandable stents following failed anterior circulation stroke thrombectomy. Wareham J, Flood R, Phan K, Crossley R, Mortimer A. Declining mortality from subarachnoid hemorrhage. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. However, rivaroxaban may be administered at 15 mg daily (reduce to 10 mg daily for creatinine clearance <50 ml/min) when combined with P2Y 12 inhibitors, based on the PIONEER-AF PCI study.Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al. When used in combination with antiplatelet medications, dosing of DOAC medications usually follows the Food and Drug Administration guidance for stroke prevention in AF or treatment of VTE. Holding a DOAC for longer periods of time may be required for patients with moderate-severe renal dysfunction, especially if using dabigatran. If aspirin is being used, it should be limited to 12 months from the most recent PCI or acute coronary syndrome can be treated with anticoagulation monotherapy.įor patients taking DOAC medications who require PCI, most DOACs can be held for no more than 36-48 hours prior to the procedure. When combined with an anticoagulant, clopidogrel is the recommended antiplatelet agent for most patients. If triple therapy is needed, a short duration (e.g., no more than 30 days) is recommended. In general, the use of “triple therapy” (dual antiplatelet therapy plus anticoagulation) is not recommended for most patients due to an increased risk of bleeding. Choosing the optimal antithrombotic regimen can be a challenge.Ĭlinical pathways are suggested for four potential clinical situations: (1) prior AF on anticoagulation and the need for PCI (2) new-onset AF requiring anticoagulation in a patient already on antiplatelet therapy for coronary artery disease (CAD) (3) prior VTE on anticoagulation and the need for PCI and (4) new or recurrent VTE requiring anticoagulation in a patient already on antiplatelet therapy for CAD. The following are key points to remember from the 2020 ACC expert consensus decision pathway for anticoagulant and antiplatelet therapy in patients with atrial fibrillation (AF) or venous thromboembolism (VTE) undergoing percutaneous coronary intervention (PCI) or with atherosclerotic cardiovascular disease:Īpproximately 10% of patients with recent PCI have concomitant AF.
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