The quest for ever-more effective drugs to decrease platelet aggregation and reduce the risk of thrombus formation, without unduly increasing the risk of bleeding, will always be a holy grail of cardiovascular disease research. With each new contender comes fresh excitement as well as more questions.
Drs Jean-Pierre Bassand, Peter Clemmensen, and Jean-Philippe Collet review the latest data on antithrombotic therapies in ACS. Hear the European perspective on antiplatelet therapy, anticoagulation agents, and anticoagulants in the setting of primary PCI.
Dr Valentin Fuster sits down with Drs William Boden, John Chapman, Keith Fox, Anne Gillis, Jessica Mega, and Clyde Yancy to tackle the brave new world of antithrombotics and to ask whether academics have left the real world, and their patients, behind.
Dr Bob Harrington sits down with Drs Alan Bell, Keith Fox, and Jean-François Tanguay for an in-depth discussion on the approach, development, methodology, and implementation of guidelines for antiplatelet therapy in Canada, the US, and Europe.
Join Drs David Kandzari, Bob Harrington, and Laura Mauri as they discuss the results of EXCELLENT and why we may need to change the way we do clinical trials to answer the real questions about dual antiplatelet therapy.
UPDATED // Just why ticagrelor did not show a mortality benefit over clopidogrel in the US and Canadian patients in the pivotal PLATO trialbelieved to be one of the main reasons the FDA has yet to approve this drugis once again thrashed out in a newly published viewpoint and two accompanying editorials.
The analysis of patients in PLATO who subsequently underwent CABG has been published, but the investigators admit they still have not managed to nail down exactly why mortality differed between the ticagrelor and clopidogrel groups, while bleeding did not. They are continuing to drill down into the data, looking at exact causes of death, and hope to have more answers on the subject in 2011.
The FDA has once again delayed a decision on the US approval of AstraZeneca's new antiplatelet drug ticagrelor, requesting additional analyses of the PLATO trial. One expert says there is much to resolve.
Read our slideshow for an overview of top research from AHA 2010 with the latest from ADVANCE, RAFT, EMPHASIS, ASCEND HF, ROCKET AF, CLOSURE I, GRAVITAS, P-OM3, PROTECT-AF, BASKET PROVE, DEFINE, SYMPLICITY HTN, ASCOT CRP, and ACT.
Dr Valentin Fuster sits down with Drs C Noel Bairey Merz, Roger Blumenthal, Sunil Rao, Renu Virmani, Lars Wallentin, and James Young for an in-depth discussion on the important trials presented at the AHA 2010 Scientific Sessions.
The first comparative clinical study of CYP2C19 genotype on ticagrelor pharmacodynamics shows that the new investigational antiplatelet agent is better at inhibiting platelet function than clopidogrel, irrespective of genotype or metabolizer status. The findings confirm the previous results of the PLATO pharmacogenetics substudy, say the researchers.
The new guidelines include recommendations on dual antiplatelet therapy duration and the role of prasugrel and COX 2 inhibitors and, for the first time, recommend against the routine use of aspirin for primary prevention.
In addition to no significant increases in bleeding with the investigational agent, investigators say atopaxar was well tolerated, achieved rapid platelet inhibition, and resulted in a significant reduction in Holter-detected ischemia.
Switching from maintenance clopidogrel to prasugrel results in a further reduction in platelet function after one week, according to a new study. When patients receive a loading dose of prasugrel prior to switching from maintenance clopidogrel, the reduction in platelet function occurs within two hours, report investigators.
A new "indirect comparative meta-analysis" of prasugrel and ticagrelor in ACS patients has suggested that prasugrel may be associated with fewer stent thromboses, whereas ticagrelor causes fewer bleeding complications.
A new, investigational antiplatelet agent, atopaxarwhich acts via a different pathway from that of aspirin and drugs such as clopidogrel and ticagrelorhas shown promising results in a phase 2 trial. Another agent from the same class, vorapaxar, is already in phase 3 trials.
Investigators showed that treatment with oral and intravenous elinogrel had more rapid antiplatelet effects than clopidogrel in the acute and chronic phases of therapy. Although still in early days, the hope is that reversible platelet inhibition may mitigate some of the bleeding risks and improve clinical outcomes.
New data from genetic substudies of PLATO and TRITON-TIMI 38 show that the efficacy of the new antiplatelet agents ticagrelor and prasugrel do not seem to be affected by loss-of-function genetic variants that contribute in some instances to worse outcomes in those on clopidogrel. Using these new agents means that routine testing for clopidogrel genetic variation is not necessary, say the authors and others; the new drugs should be used when possible in patients with a medium to high risk of thrombotic complications after stenting.