Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Platelet activation and aggregation have become increasingly recognized as the primary processes involved in the cascade that leads to thrombus formation in atherosclerotic vascular disease. Glycoprotein IIb/IIIa receptor inhibitors (GPI) favorably impact thrombus formation and distal embolization by inhibiting the final common pathway of platelet aggregation. Glycoprotein IIb/IIIa inhibitors have been used effectively in a wide variety of clinical scenarios including unstable angina, non-ST segment elevation myocardial infarction, ST segment elevation myocardial infarction, and low and high risk percutaneous coronary interventions with and without intracoronary stenting, however there is limited data regarding the use of these potent antiplatelet agents in the setting of extracardiac vascular disease. This article will review the non-cardiac applications of glycoprotein IIb/IIIa inhibitors in the setting of acute ischemic stroke, carotid and vertebral angioplasty and stenting, acute critical limb ischemia, and percutaneous interventions in peripheral arterial occlusive disease.
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PMID:Noncardiac applications of glycoprotein IIb/IIIa inhibitors. 1527 67

Antiphospholipid (aPL) antibodies entailing anticardiolipin (aCL) and anti-beta2 glycoprotein I (anti-beta2GPI) antibodies may be involved in a number of vascular diseases including coronary artery diseases (CAD) or stroke. Here we assessed the presence of aPL antibodies in acute coronary syndrome (ACS). The frequency of anti-beta2GPI antibodies was significantly higher (14.4%) in ACS in comparison to control healthy subjects (2%). In addition, serum concentrations of anti-beta2GPI antibodies were also increased in ACS. Anti-beta2GPI antibodies of the IgA isotype might be the most relevant for the onset and outcome of ACS. Regarding subclasses of ACS, anti-beta2GPI IgA antibodies were elevated in unstable angina (UA) and myocardial infarction with ST elevation (STEMI), but not in myocardial infarction without ST elevation (NSTEMI). The involvement of anti-beta2GPI antibodies in ACS was more pronounced in men than women, and in younger rather than older patients. Finally, anti-beta2GPI antibodies in ACS were associated with previous stroke, but not with hypertension or previous myocardial infarction. Thus, anti-beta2GPI antibodies may be involved in the thrombotic events underlying ACS.
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PMID:Antiphospholipid antibodies in acute coronary syndrome. 1530 68

Coronary heart disease is the number one cause of death in the world and acute coronary syndromes (ACS) continue to be associated with high rates of morbidity. ACS refers to the spectrum of acute myocardial ischemia, including unstable angina, ST segment elevation myocardial infarction (STEMI), and acute MI without ST segment elevation (NSTEMI). Current guidelines indicate both aspirin and glycoprotein IIb/IIIa receptor antagonists (if catheterization/revascularization are planned) as class IA recommendations in ACS. Anticoagulant therapy, in the form of heparin, is a class IA recommendation for the acute hospital phase of ACS. The risk of recurrent thrombotic events following ACS remains high in the post-hospital phase, creating a rationale for the use of oral direct thrombin inhibitors such as ximelagatran, in both the acute and long-term settings. The Efficacy and Safety of the Oral Direct Thrombin Inhibitor Ximelagatran in Patients with Recent and Myocardial Damage (ESTEEM) trial, a placebo-controlled, double-blind study of post-MI patients, evaluated 4 dosing regimens of ximelagatran versus placebo in the initial months following an ACS and found an encouraging reduction in the end points of death, MI, and stroke with the use of an oral direct thrombin inhibitor.
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PMID:Reducing cardiac events after acute coronary syndromes. 1561 14

In patients with stable CAD, PCI can be considered a valuable initial mode of revascularization in all patients with objective large ischaemia in the presence of almost every lesion subset, with only one exception: chronic total occlusions that cannot be crossed. In early studies, there was a small survival advantage with CABG surgery compared with PCI without stenting. The addition of stents and newer adjunctive medications improved the outcome for PCI. The decision to recommend PCI or CABG surgery will be guided by technical improvements in cardiology or surgery, local expertise, and patients' preference. However, until proved otherwise, PCI should be used only with reservation in diabetics with multi-vessel disease and in patients with unprotected left main stenosis. The use of drug-eluting stents might change this situation. Patients presenting with NSTE-ACS (UA or NSTEMI) have to be stratified first for their risk of acute thrombotic complications. A clear benefit from early angiography (<48 h) and, when needed, PCI or CABG surgery has been reported only in the high-risk groups. Deferral of intervention does not improve outcome. Routine stenting is recommended on the basis of the predictability of the result and its immediate safety. In patients with STEMI, primary PCI should be the treatment of choice in patients presenting in a hospital with PCI facility and an experienced team. Patients with contra-indications to thrombolysis should be immediately transferred for primary PCI, because this might be their only chance for quickly opening the coronary artery. In cardiogenic shock, emergency PCI for complete revascularization may be life-saving and should be considered at an early stage. Compared with thrombolysis, randomized trials that transferred the patients for primary PCI to a 'heart attack centre' observed a better clinical outcome, despite transport times leading to a significantly longer delay between randomization and start of the treatment. The superiority of primary PCI over thrombolysis seems to be especially clinically relevant for the time interval between 3 and 12 h after onset of chest pain or other symptoms on the basis of its superior preservation of myocardium. Furthermore, with increasing time to presentation, major-adverse-cardiac-event rates increase after thrombolysis, but appear to remain relatively stable after primary PCI. Within the first 3 h after onset of chest pain or other symptoms, both reperfusion strategies seem equally effective in reducing infarct size and mortality. Therefore, thrombolysis is still a viable alternative to primary PCI, if it can be delivered within 3 h after onset of chest pain or other symptoms. Primary PCI compared with thrombolysis significantly reduced stroke. Overall, we prefer primary PCI over thrombolysis in the first 3 h of chest pain to prevent stroke, and in patients presenting 3-12 h after the onset of chest pain, to salvage myocardium and also to prevent stroke. At the moment, there is no evidence to recommend facilitated PCI. Rescue PCI is recommended, if thrombolysis failed within 45-60 min after starting the administration. After successful thrombolysis, the use of routine coronary angiography within 24 h and PCI, if applicable, is recommended even in asymptomatic patients without demonstrable ischaemia to improve patients' outcome. If a PCI centre is not available within 24 h, patients who have received successful thrombolysis with evidence of spontaneous or inducible ischaemia before discharge should be referred to coronary angiography and revascularized accordingly--independent of 'maximal' medical therapy.
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PMID:Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. 1676 Feb 7

The European Community has named five emergencies as being priorities. These five emergencies are: the cardiorespiratory arrest, the myocardial infarction, the severe polytrauma, the cerebral vascular accident and the severe acute dyspnoea. In this article three of them are discussed. Seen with the eyes of a generalist the severe polytrauma requires simple gestures, such as an early call for help by the SMUR, axialisation of head, trunk and members, compression of overtly sources of bleeding and opening the airway to facilitate breathing. The acute myocardial infarction continues to pose problems of diagnosis. The pathognomonic presentations are the STEMI and the N-STEMI infarction. In these cases it is a priority to call for the help of a SMUR unit. In the case of a STEMI infarction it is an absolute priority to admit the patient quickly to hospital and to directly move on to the coronarography ward for a primary angioplasty procedure. Within the first three hours of the infarction, if primary angioplasty is not a possibility within the first 90 minutes, thrombolysis is absolutely indicated. In the case of N-STEMI infarction a quick admission to a coronary care unit is urgent but the treatment is mainly medical. The cerebral vascular incident occurs more frequently than the myocardial infarction, but, culturally, not enough importance is attached to this pathology. Within the first three hours the aim is to get the patient to an emergency department (by means of the SMUR), to evaluate the coagulation values of the patient and to perform a head scan (without the injection of contrast) of good quality. If the patient is not too severely incapacitated (NIH score between 4 and 25), if the head scan does not show a hemorrhagic lesion and if there is no contraindication for thrombolysis, Actilyse should be administered. The time it takes to do all of these acts can not exceed the above mentioned three hours.
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PMID:[The first our quintet or the channel of care for the most usual urgent pathologies]. 1795 16

The Clinical Trials described in this article were presented at the Hotline and Clinical Trial Update Sessions of the European Society of Cardiology Congress held in September 2007 in Vienna, Austria. The sessions chosen for this article represent the scope of interest of Cardiovascular Drugs and Therapy. The presentations should be considered preliminary, as further analyses could alter the final publication of the results of these studies. PROSPECT evaluated echocardiographic criteria for optimal selection of patients with moderate to severe heart failure who may benefit from cardiac resynchronisation therapy, however concluded that no single echocardiographic measure can be recommended. EVEREST found that tolvaptan, a vasopressin V(2) antagonist, resulted in early weight reduction and improvement of dyspnoea in patients with acute heart failure, but lacked long term improvement. In ARISE, the anti-oxidant succinobucal did not affect the primary outcome in high risk cardiovascular patients, but improved the combination of cardiovascular death, myocardial infarction and stroke, and diabetic control in diabetics. ALOFT showed that the addition of the renin inhibitor aliskiren to an ACE inhibitor or ARB and a beta-blocker leads to favourable effects on neurohormonal actions in heart failure. FINESSE markedly improved coronary patency before PCI with half-dose reteplase/abciximab in STEMI patients, however without significantly improving short-term outcome. The Prague-8 Study evaluated whether routine clopidogrel administered >6 h pre-angiography would be a safe way to achieve therapeutic drug levels in case a follow-up intervention would be considered immediately, but appeared not justified because of bleeding complications. CARESS in MI showed that high risk patients with evolving STEMI who undergo thrombolytic therapy should undergo PCI early after the thrombolysis. Finally, the ACUITY trial found that in moderate or high risk Non ST elevation ACS patients triaged to PCI, coronary artery bypass graft (CABG) surgery, or medical management, bivalirudin, with or without associated GPIIb/IIIa inhibitor therapy, resulted in a marked reduction of bleeding at 30 days whilst preserving the ischemic and mortality benefit at 1 year follow up.
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PMID:Clinical trials update from the European Society of Cardiology Congress in Vienna, 2007: PROSPECT, EVEREST, ARISE, ALOFT, FINESSE, Prague-8, CARESS in MI and ACUITY. 1799 67

Evidence from randomized controlled clinical trials and registries suggest that primary percutaneous coronary intervention provides superior clinical outcomes when compared with fibrinolytic therapy for the treatment of ST segment elevation myocardial infarction (STEMI). However, the delivery of expert and timely primary percutaneous coronary intervention to the majority of patients with STEMI is extremely challenging. This objective has fueled the concept of regional centers of excellence for the care of patients with STEMI as well as regional STEMI networks similar to those currently available for trauma or stroke victims. This article reviews the rationale behind, as well as the issues inherent to, the development of systems of care for STEMI patients.
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PMID:Specialized centers and systems for heart attack care. 1825 53

The AHA has released its annual selection of the 10 top major advances in heart disease and stroke research for 2007. This list is very interesting. It contains papers on genetics which present the newly introduced genome-wide association studies of different common diseases, including coronary artery disease. The results of investigations carried out on cardiomyocytes derived from adult mouse spermatogonial stem-cells are mentioned. The value of angioplasty in chronic stable coronary artery disease is reassessed as is the need for mouth to mouth ventilation in resuscitation manoeuvres for cardiac arrest. The effectiveness and safety of drug-eluting stents in routine clinical practice is demonstrated and the merit of bivaluridin for the treatment of patients with a STEMI infarct is described. The improvement in quality of care provided by a statewide system for coronary revascularisation is outlined. Finally, two papers are devoted to epidemiological issues: one demonstrates that a reduced sodium intake lowers not only blood pressure, but also the risk of clinical cardiovascular disease outcomes; the second stresses that hypertension and prehypertension are often undiagnosed in the pediatric population.
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PMID:[The top ten major advances in heart disease and stroke research in 2007: a selection of the American Heart Association]. 1856 67

It has been reported that early use of statins in STEMI and NSTEMI as in acute coronary syndrome protects patients from recurrent ischemic events. Thus, it may reduce both short-term and long-term adverse outcomes such as subsequent cardiovascular mortality, myocardial infarction and revascularization, as well as stroke. It seems that this protective effect takes place as early as four months of treatment initiation, as reported in the MIRACL trial. The potential benefit slowly increases over time for up to 24 months of treatment initiation. Pleiotropic effects of statins, i.e. mechanisms such as improvement of endothelial dysfunction, antithrombotic and fibrinolytic as well as anti-inflammatory effects are possible explanations for this early effect. Therefore, the initiation of treatment with statins during hospitalization as part of acute phase therapy is advised. Relatively few patients need to be treated in such a way to prevent one death, so this approach is also cost-effective.
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PMID:[The role of statins in secondary prevention of STEMI and NSTEMI: when to start with statin treatment?]. 1968 68

Activation of the coagulation cascade and platelet functions occurs in ACS and may lead to subsequent thrombus formation, vessel occlusion, distal embolisation, myocardial ischaemia, necrosis and eventually death. Over the last 20 years, the outcome of ACS and PCI patients has considerably improved, thanks to better pharmacologic environment, urgent reperfusion in STEMI (ST elevation myocardial infarction), timely revascularisation in non-ST elevation ACS (NSTEACS) and improved PCI techniques, particularly widespread use of stents. In this context, bleeding was long considered as inherent to the modern therapeutic approach and without real consequences. Actually, bleeding has a strong impact on outcome, with a four- to five-fold increase in the rate of death, myocardial infarction and stroke at 30 days and six months. In addition, blood transfusion may have deleterious effects. Recent evidence shows that reduced risk of bleeding leads to a reduced risk of ischemic events (death, myocardial infarction and stroke). The exact mechanisms by which bleeding impacts on outcome are as yet poorly understood. The interruption of active treatment may play an important role. Activation of coagulation or inflammation in case of bleeding, and depletion of 2,3DPG and nitric oxide, inflammatory and immunologic reactions triggered by blood transfusion, are among the potential mechanisms. Prevention of bleeding has become as important as prevention of ischaemic events. Risk stratification for bleeding is as important as overall risk stratification for further ischaemic events. In patients at high risk of bleeding, appropriate choice and dosage of drugs, combinations of drugs, and the use of radial rather than femoral approach are essential components of bleeding prevention.
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PMID:Acute Coronary Syndromes and Percutaneous Coronary Interventions: impact of bleeding and blood transfusion. 1988 79


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