Beneficial Effects of Clopidogrel Combined With Aspirin in Reducing Cerebral Emboli in Patients Undergoing Carotid Endarterectomy
David A. Payne,Chris I. Jones,Paul D. Hayes,Matt M. Thompson,Nicholas J.M. London,Peter R.F. Bell,Alison H. Goodall,A. Ross Naylor +7 more
TLDR
This is the first study to show that a CEA patient’s postoperative thromboembolic potential can be significantly reduced by targeted preoperative antiplatelet therapy without increasing the risk of bleeding complications.Abstract:
Background— Postoperative thromboembolic stroke affects 2% to 3% of patients undergoing carotid endarterectomy (CEA) and is preceded by 1 to 2 hours of increasing cerebral embolization. Previous work has demonstrated that high rates of postoperative embolization are associated with increased platelet reactivity to adenosine 5′-diphosphate (ADP). Our hypothesis was that preoperative administration of the platelet ADP antagonist clopidogrel could reduce postoperative embolization. Methods and Results— One hundred CEA patients on routine aspirin therapy (150 mg) were randomized to 75 mg clopidogrel (n=46) or placebo (n=54) the night before surgery. Platelet response to ADP was assessed by whole-blood flow cytometry. The number of emboli detected by transcranial Doppler within 3 hours of CEA was independently quantified. Time taken from flow restoration to skin closure was used as an indirect measure of the time to secure hemostasis. In comparison with placebo, clopidogrel produced a small (8.8%) but signific...read more
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Aspirin plus Clopidogrel as Secondary Prevention after Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis
Qinghua Zhang,Chao Wang,Maoyong Zheng,Yanxia Li,Jincun Li,Liping Zhang,Xiao Shang,Chuanzhu Yan +7 more
TL;DR: Short-term aspirin in combination with clopidogrel is more effective as secondary prevention of stroke or TIA without increasing the risk of hemorrhagic stroke and major bleeding events and the clinical applicability of the findings of this systematic review needs to be confirmed in future clinical trials.
Journal ArticleDOI
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)
Lee A. Fleisher,Joshua A. Beckman,Kenneth A. Brown,Hugh Calkins,Elliott Chaikof,Kirsten E. Fleischmann,William K. Freeman,James B. Froehlich,Edward K. Kasper,Judy R. Kersten,Barbara Riegel,John F. Robb,Sidney C. Smith,Alice K. Jacobs,Cynthia D. Adams,Jeffrey L. Anderson,Elliott M. Antman,Christopher E. Buller,Mark A. Creager,Steven M. Ettinger,David P. Faxon,Valentin Fuster,Jonathan L. Halperin,Loren F. Hiratzka,Sharon A. Hunt,Bruce W. Lytle,Rick A. Nishimura,Joseph P. Ornato,Richard L. Page,Lynn G. Tarkington,Clyde W. Yancy +30 more
TL;DR: The 2007 Guidelines on Perioperative Cardiovascular Evaluation for Non-Cardiac Surgery (e159-e242) as discussed by the authors were developed by the American College of ACC/AHA Task Force on Practice Guidelines Care for Noncardiac Surgery.
Journal ArticleDOI
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)
Lee A. Fleisher,Joshua A. Beckman,Kenneth A. Brown,Hugh Calkins,Elliott Chaikof,Kirsten E. Fleischmann,William K. Freeman,James B. Froehlich,Edward K. Kasper,Judy R. Kersten,Barbara Riegel,John F. Robb,Sidney C. Smith,Alice K. Jacobs,Cynthia D. Adams,Jeffrey L. Anderson,Elliott M. Antman,Christopher E. Buller,Mark A. Creager,Steven M. Ettinger,David P. Faxon,Valentin Fuster,Jonathan L. Halperin,Loren F. Hiratzka,Sharon A. Hunt,Bruce W. Lytle,Rick A. Nishimura,Joseph P. Ornato,Richard L. Page,Lynn G. Tarkington,Clyde W. Yancy +30 more
TL;DR: WRITING COMMITTEE MEMBERS Lee A. Fleisher, MD, FACC, FAHA, Chair; Joshua A. Beckman,MD, F ACC¶; Kenneth A. Kasper, MD; Judy R. Kersten,MD; Barbara Riegel, DNSc, RN,FAHA.
Journal Article
[ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery].
TL;DR: ACC/AHA TASK FORCE MEMBERS Sidney C. Smith, Jr, MD, FACC, FAHA, Chair; Alice K. Jacobs, MD., Vice Chair; Cynthia D. Tarkington, RN; Clyde W. Yancy,MD, F ACC.
Journal ArticleDOI
2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
Lee A. Fleisher,Joshua A. Beckman,Kenneth A. Brown,Hugh Calkins,Elliot L. Chaikof,Kirsten E. Fleischmann,William K. Freeman,James B. Froehlich,Edward K. Kasper,Judy R. Kersten,Barbara Riegel,John F. Robb +11 more
TL;DR: It is essential that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced and tested in the detection, management, or prevention of disease states.
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Journal Article
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