BARRIERS OF ANTIAGGREGANT TREATMENT

Authors

  • Irina GIRLEANU University of Medicine and Pharmacy“Grigore T. Popa”-Iaşi
  • D. M. ALEXANDRESCU Cardiovascular Diseases Institute “George I. M. Georgescu” Iaşi
  • A. O. PETRIS “Sf. Spiridon” Emergency Clinical Hospital, Iaşi
  • Irina-Iuliana COSTACHE “Sf. Spiridon” Emergency Clinical Hospital, Iaşi

Keywords:

ANTIAGGREGANT TREATMENT, CLOPIDOGREL, ASPIRIN, HEMORRHAGE, SIDE EFFECTS.

Abstract

In the present study we aimed to evaluate side effects of antiplatelet therapy in order to establish correlations with medication type, doses and association with other therapies. Material and methods: in the study we prospectively evaluated a cohort of patients who received antiplatelet therapy for different pathologies.  We included patients with acute coronary syndromes, valvular disease complicated with supraventricular arrhythmias (especially atrial fibrillation), carotidal critical stenosis, neurologic disease (ischemic or thrombotic), and peripheral artery disease. Results and discussions: The study included 125 patients (85 males and 40 females), aged between 45 and 85, and admitted in the 1st Cardiology Department, St Spiridon Hospital, between January 2012 and December 2013, who received antiplatelet therapy for different pathologies. All the patients included in the study received platelet antiaggregant therapy with Clopidogrel in association or not with Aspirin or low weight molecular heparin. Side effects reported (possibly correlated with antiplatelet therapy) were: macroscopic hematuria (7 cases), cutaneous ecchymosis (7 cases), purpuric lesions (9 cases), gingival bleeding (12 cases), upper gastrointestinal bleeding (6 cases), and hemoptysis (2 cases). Conclusions: Hemorrhagic events under the treatment with antiplatelet agents are rare in comparison with the large number of patients treated. Clinical manifestations are very different depending on the drug and also on the drug-associations used. Hemorrhagic accidents may sometimes be very serious, determining the specific therapeutic measures.

Author Biographies

  • Irina GIRLEANU, University of Medicine and Pharmacy“Grigore T. Popa”-Iaşi

    Faculty of Medicine
    Department of Gastroenterology

  • A. O. PETRIS, “Sf. Spiridon” Emergency Clinical Hospital, Iaşi

    “C.I. Negoiţă” 1st Medical Cardiology Clinic

  • Irina-Iuliana COSTACHE, “Sf. Spiridon” Emergency Clinical Hospital, Iaşi

    “C.I. Negoiţă” 1st Medical Cardiology Clinic

References

1. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: Part II: Variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation. 2001; 104(23): 2855-2864.
2. Husted S. Evidence-based prescribing and adherence to antiplatelet therapy-how much difference do they make to patients with atherothrombosis? Int J Cardiol 2009; 134: 150-159.
3. Jagroop IA, Matsagas MI, Geroulakos G, Mikhailidis DP. The effect of clopidogrel, aspirin and both antiplatelet drugs on platelet function in patients with peripheral arterial disease. Platelets 2004; 15(2): 117-125.
4. Costache II, Rusu C, Ivanov I, Popescu R, Petriş A. Clopidogrel resistance--risk factor in patients with acute coronary syndromes. Rev Med Chir Soc Med Nat Iasi 2012; 116(2): 383-388.
5. Deepak L. Bhatt, M.D., Keith A.A. Fox, et al for the CHARISMA Investigators Clopidogrel and Aspirin versus Aspirin Alone for the Prevention of Atherothrombotic Events. N Engl J Med 2006; 354: 1706-1717.
6. Diener HC, Bogousslavsky J, Brass LM, et al. MATCH investigators. Aspirin and clopidogrel com-pared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004; 364(9431): 331-337.
7. Payne DA, Jones CI, Hayes PD, et al. Beneficial effects of clopidogrel combined with aspirin in reducing cerebral emboli in patients undergoing carotid endarterectomy. Circulation 2004; 109(12): 1476-1481.
8. Markus HS, Droste DW, Kaps M, et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using Doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 2005; 111(17): 2233-2240.
9. Eisenstein EL, Anstrom KJ, Kong DF, et al: Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA 2007; 297: 159-168.
10. Ng FH, Wong SY, Lam KF, et al. Gastrointestinal bleeding in patients receiving a combination of aspirin, clopidogrel, and enoxaparin in acute coronary syndrome. Am J Gastroenterol 2008; 103: 865-871.
11. Subherwal S, Bach RG, Chen AY, et al. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation 2009; 119(14): 1873-1882.
12. Patel PD, Arora RR. Practical implications of ACC/AHA 2007 guidelines for the management of unstable angina/non-ST elevation myocardial infarction. Am J Ther 2010; 17(1): e24-40.
13. Mehta SR, Yusuf S. Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) Study Investigators. The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial pro-gramme; rationale, design and baseline characteristics including a meta-analysis of the effects of thienopyridines in vascular disease. Eur Heart J 2000; 21(24): 2033-2041.
14. Al Badarin FJ, Spertus JA, Gosch KL, Buchanan DM, Chan PS. Initiation of statin therapy after acute myocardial infarction is not associated with worsening depressive symptoms: insights from the Pro-spective Registry Evaluating Outcomes After Myocardial Infarctions: Events and Recovery (PREM-IER) and Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) registries. Am Heart J 2013; 166(5): 879-886.

Additional Files

Published

2018-05-02

Issue

Vol. 118 No. 2 (2014): The Medical-Surgical Journal

Section

INTERNAL MEDICINE - PEDIATRICS

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