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Antithrombotic Therapy for Transcatheter Coronary and Structural Heart Interventions

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (5 April 2022) | Viewed by 5893

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Special Issue Editors

Prof. Dr. Paolo Calabrò

E-Mail Website1 Website2
Guest Editor

Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Caserta, Italy
Interests: dyslipidemia; ischemic heart disease; atrial fibrillation; hypertension; acute coronary syndrome; heart failure; cardioncology
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Dr. Felice Gragnano

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Guest Editor

1. Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Caserta, Italy
2. Division of Clinical Cardiology, AORN "Sant'Anna e San Sebastiano", Caserta, Italy
Interests: antithrombotic therapy; bleeding risk; ischemic risk; acute coronary syndrome; percutaneous coronary intervention; transcatheter interventions for structural heart disease

Prof. Dr. Dominick J. Angiolillo

E-Mail Website
Guest Editor

Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
Interests: antithrombotic therapy; antiplatelet therapy; platelet function tests; percutaneous coronary intervention; transcatheter interventions for structural heart disease

Special Issue Information

Dear Colleagues,

Contemporary evidence supports the use of transcatheter interventions for the management of patients with coronary and structural heart disease. These procedures—which include percutaneous coronary intervention (PCI), transcatheter aortic valve implantation (TAVI), mitral or tricuspid valve repair/implantation, left atrial appendage occlusion (LAAO), and patent foramen ovale (PFO) closure—differ in clinical indications and technical aspects.

Patients undergoing transcatheter cardiac interventions require antithrombotic therapy, including antiplatelet and anticoagulant agents, to prevent thromboembolic events. Yet, these therapies are associated with an increased risk of spontaneous and procedure-related bleeding complications. To date, numerous challenges exist in balancing the risk of ischemic and bleeding events in these patients, such that the optimal antithrombotic regimen to adopt in each individual patient and procedure is a topic of clinical relevance.

It is our honor and pleasure to invite you to contribute to this Special Issue of the Journal of Clinical Medicine, which will focus on antithrombotic therapies among patients undergoing transcatheter interventions for coronary and structural heart disease, emphasizing the importance of an individualized treatment strategy.

Prof. Dr. Paolo Calabrò
Dr. Felice Gragnano
Prof. Dr. Dominick J. Angiolillo
Guest Editors

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Keywords

antithrombotic therapy

antiplatelet therapy

non-vitamin K antagonist oral anticoagulants (NOACs)

bleeding

percutaneous coronary intervention

transcatheter aortic valve implantation (TAVI)

mitral valve

tricuspid valve

left atrial appendage occlusion (LAAO)

patent foramen ovale (PFO) closure

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Published Papers (3 papers)

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Research

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10 pages, 1040 KiB

Open AccessArticle

Reticulated Platelets and Their Relationship with Endothelial Progenitor Cells during the Acute Phase of ST-Elevation Myocardial Infarction

by Nili Schamroth Pravda, Mark Kheifets, Maya Wiessman, Dorit Leshem-Lev, Hana Vaknin Assa, Ran Kornowski, Yeela Talmor-Barkan and Leor Perl

J. Clin. Med. 2022, 11(21), 6597; https://doi.org/10.3390/jcm11216597 - 7 Nov 2022

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Abstract

Introduction: Endothelial progenitor cells (EPC) and reticulated platelets (RP) have central roles in the thrombotic and angiogenetic interactions during ST-elevation myocardial infarction (STEMI). The EPC and RP response in patients with STEMI treated by primary percutaneous intervention (PPCI) has not yet been investigated. Methods: We assessed EPC quantification by the expression of CD133⁺ and CD34⁺, and EPC function by the capacity of the cells to form colony-forming units (CFU) and MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) during the acute phase of STEMI. These measurements were correlated with RP at baseline and after 24 h following PPCI. Results: Our cohort included 89 consecutive STEMI-diagnosed patients enrolled between December 2018 and July 2021. At baseline, there was a strong positive correlation between reticulated platelet quantity and MTT levels (R = 0.766 and R² = 0.586, p < 0.001), CD34⁺ levels (R = 0.602, and R² = 0.362, p < 0.001); CD133⁺ levels (R = 0.666 and R² = 0.443, p < 0.001) and CFU levels (R = 0.437, R² = 0.191, p < 0.001). The multiple linear regression showed that levels of MTT (adjusted R² = 0.793; p < 0.001), CD34⁺ and CD133⁺ (adjusted R² = 0.654; p < 0.001 and adjusted R² = 0.627; p < 0.001, respectively) had strong independent correlations with RP response. At 24 h after PPCI, the correlation between RP quantity and EPC markers was not significant, except for MTT levels (R = 0.465, R² = 0.216, p < 0.001). Conclusions: In patients with STEMI, higher levels of RP at baseline are significantly correlated with a more potent EPC response. The translational significance of these findings needs further investigation. Full article

(This article belongs to the Special Issue Antithrombotic Therapy for Transcatheter Coronary and Structural Heart Interventions)

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10 pages, 1347 KiB

Open AccessArticle

Prognosis of Atrial Fibrillation Patients Undergoing PCI According to Anticoagulants and Antiplatelet Agents

by Gwang-Seok Yoon, Sun-Hwa Kim, Si-Hyuck Kang, Chang-Hwan Yoon, Young-Seok Cho, Tae-Jin Youn and In-Ho Chae

J. Clin. Med. 2021, 10(15), 3370; https://doi.org/10.3390/jcm10153370 - 29 Jul 2021

Cited by 2 | Viewed by 1960

Abstract

There are limited data evaluating conformation of antithrombotic therapy usage to the guideline recommendations. We investigated clinical trends and prognoses of patients with atrial fibrillation (AF) according to anticoagulants and antiplatelet agents beyond 1 year after percutaneous coronary intervention (PCI). We analyzed the records of patients with AF who underwent PCI using the Korean National Health Insurance Service database. The primary endpoint was a composite of major adverse cardiac events (MACE). The safety outcome was bleeding complications. Of 4193 participants, 81.6% received antiplatelet therapy, whereas 27.3% had oral anticoagulant (OAC)-based therapy at 18 months after PCI. The dominant therapy was dual antiplatelet therapy (37.2%), and only 3.3% of participants had OAC monotherapy. At the 1-year follow-up, the incidence of MACE was significantly lower among those receiving a combination of OAC and single antiplatelet therapy (SAPT) than among those receiving OAC monotherapy (4.78% vs. 9.42%, p = 0.017). Bleeding complication events (5.01% vs. 5.80%, p = 0.587) did not differ between the groups. In clinical practice, most patients with AF who underwent PCI continued to receive antiplatelet agents beyond 1-year post-PCI. OAC with SAPT seemed to be more effective than OAC monotherapy, without a difference in safety. Full article

(This article belongs to the Special Issue Antithrombotic Therapy for Transcatheter Coronary and Structural Heart Interventions)

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Review

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13 pages, 1571 KiB

Open AccessReview

Escalation and De-Escalation of Antiplatelet Therapy after Acute Coronary Syndrome or PCI: Available Evidence and Implications for Practice

by Felice Gragnano, Antonio Capolongo, Fabrizia Terracciano, Giuseppe Gargiulo, Vincenzo De Sio, Arturo Cesaro, Elisabetta Moscarella, Giuseppe Patti, Italo Porto, Giovanni Esposito, Dominick J. Angiolillo and Paolo Calabrò

J. Clin. Med. 2022, 11(21), 6246; https://doi.org/10.3390/jcm11216246 - 23 Oct 2022

Cited by 4 | Viewed by 3759

Abstract

Dual antiplatelet therapy (DAPT) is the gold standard for the antithrombotic management of patients with an acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). Implementation of intensified or prolonged DAPT regimens has proven to lower the risk of ischemic events but at the expense of increased bleeding. Importantly, bleeding is a predictor of poor prognosis. Risk stratification and selection of tailored antiplatelet strategies to maximize the net clinical benefit in individual patients with ACS or undergoing PCI is therefore potentially beneficial. Recently, novel approaches including DAPT de-escalation or escalation have been proposed as possible alternatives to standard DAPT. These strategies, which are generally based on patient’s risk profile, genetics, and/or platelet function have been proposed to offer more tailored treatments in patients with ACS or PCI, with the ultimate goal of providing adequate ischemic protection while mitigating the risk of bleeding. This review summarizes the available evidence on DAPT de-escalation or escalation (both guided and unguided) and discusses the practical implications of these strategies in the contemporary management of patients with ACS and/or undergoing PCI. Full article

(This article belongs to the Special Issue Antithrombotic Therapy for Transcatheter Coronary and Structural Heart Interventions)

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Antithrombotic Therapy for Transcatheter Coronary and Structural Heart Interventions

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