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| 1 | Clinical importance of aspirin and clopidogrel resistance显示文摘Aspirin and clopidogrel are important components of medical therapy for patients with acute coronary syndromes, for those who received coronary artery stents and in the secondary prevention of ischaemic stroke. Despite their use, a significant number of patients experience recurrent adverse ischaemic events. Interindividual variability of platelet aggregation in response to these antiplatelet agents may be an explanation for some of these recurrent events, and small trials have linked 'aspirin and/or clopidogrel resistance', as measured by platelet function tests, to adverse events. We systematically reviewed all available evidence on the prevalence of aspirin/clopidogrel resistance, their possible risk factors and their association with clinical outcomes. We also identified articles showing possible treatments. After analyzing the data on different laboratory methods, we found that aspirin/clopidogrel resistance seems to be associated with poor clinical outcomes and there is currently no standardized or widely accepted definition of clopidogrel resistance. Therefore, we conclude that specific treatment recommendations are not established for patients who exhibit high platelet reactivity during aspirin/clopidogrel therapy or who have poor platelet inhibition by clopidogrel. | Gergely Feher Andrea Feher Gabriella Pusch Katalin Koltai Antal Tibold Beata Gasztonyi Elod Papp Laszlo Szapary Gabor Kesmarky Kalman Toth | 2010 | World Journal of Cardiology2010，2，7： | 36 |
| 2 | De-escalation of anti-platelet therapy in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a narrative review显示文摘Objective:Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the cornerstone of treatment in patients with acute coronary syndromes (ACS) and in those undergoing percutaneous coronary intervention (PCI).In current clinical situation, availability of different oral P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor) has enabled physicians to switch among therapies owing to specific clinical scenarios.Although optimum time, loading dose and interval of transition between P2Y12 inhibitors is still controversial and needs further evidence, switching between oral inhibitors frequently occurs in clinical practice for several reasons.Data sources:This review was based on data in articles published in PubMed up to June 2018, with the following keywords 'antiplatelet therapy' , 'ACS' , 'PCI' , 'ticagrelor' and 'clopidogrel' .Study selection:Original articles and critical reviews on de-escalation strategy in ACS patients after PCI were selected.References of the retrieved articles were also screened to search for potentially relevant papers.Results:Safety concerns associated with switching between antiplatelet agents, has prompted the use of clopidogrel for patients with ACS especially after PCI as a de-escalation strategy.Practical considerations for de-escalating therapies in patients with ACS such as reducing dose of P2Y12 inhibitors or shortening duration of DAPT (followed by aspirin or P2Y12 receptor inhibitor monotherapy) as potential options are yet to be standardized and validated.Conclusions:Current review will provide an overview of the pharmacology of common P2Y12 inhibitors, definitions of deescalation and different de-escalating strategies and its outcomes, along with possible direction to be explored in de-escalation. | Ya-Ling Han | 2019 | Chinese Medical Journal2019，，2： | 16 |
| 3 | Current status of high on-treatment platelet reactivity in patients with coronary or peripheral arterial disease:Mechanisms,evaluation and clinical implications显示文摘Antiplatelet therapy with aspirin or clopidogrel or both is the standard care for patients with proven coronary or peripheral arterial disease,especially those undergoing endovascular revascularization procedures. However,despite the administration of the antiplatelet regiments,some patients still experience recurrent cardiovascular ischemic events. So far,it is well documented by several studies that in vitro response of platelets may be extremely variable. Poor antiplatelet effect of clopidogrel or high on-treatment platelet reactivity(HTPR) is under investigation by numerous recent studies. This review article focuses on methods used for the ex vivo evaluation of HTPR,as well as on the possible underlying mechanisms and the clinical consequences of this entity. Alternative therapeutic options and future directions are also addressed. | Stavros Spiliopoulos Georgios Pastromas | 2015 | World Journal of Cardiology2015，7，12： | 13 |
| 4 | Treatment and prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy显示文摘Antiplatelet therapy is the standard of care for the secondary prevention of acute coronary syndrome and ischemic stroke, especially after coronary intervention. However, this therapy is associated with bleeding complications such as gastrointestinal bleeding, which is one of the most common life-threatening complications. Early endoscopy is recommended for most patients with acute upper gastrointestinal bleeding. After successful endoscopic hemostasis, immediate resumption of antiplatelet therapy with proton-pump inhibitors(PPIs) is recommended to prevent further ischemic events. PPI prophylaxis during antiplatelet therapy reduces the risk of upper gastrointestinal bleeding. The potential negative metabolic interaction between PPIs and clopidogrel is still unclear. | Hiroshi Yasuda Yasumasa Matsuo Yoshinori Sato Sun-ichiro Ozawa Shinya Ishigooka Masaki Yamashita Hiroyuki Yamamoto Fumio Itoh | 2015 | World Journal of Critical Care Medicine2015，4，1： | 13 |
| 5 | 2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI显示文摘East Asians are the most populous race in the world and their health status is an important global issue.Compared with Caucasian populations, East Asian patients have a different benefit/risk ratio when using antithrombotic treatment. Despite this observation, treatment strategies in East Asian patients are mostly based on the American and European guidelines. Despite a lower platelet inhibitory response to clopidogrel, East Asian patients show a similar or even a lower rate of ischemic event occurrence and higher bleeding risk compared with Caucasian patients. For potent P2Y_(12) inhibitors(ticagrelor and prasugrel),East Asian patients have shown less favorable net clinical benefits compared with Caucasian patients,which may be related to differences in pharmacokinetic/pharmacodynamic profiles and therapeutic zone of antiplatelet effect. This updated consensus mainly focuses on state-of-the-art and current controversies in the East Asian population. In addition, when East Asian patients are administered potent P2Y_(12) receptor inhibitors, the strategies and ongoing trials to overcome the related hurdles are discussed. | Yong Huo Young-Hoon Jeong Yanjun Gong Daowen Wang Ben He Jiyan Chen Guosheng Fu Yundai Chen Jianping Li Yi Li Shinya Goto Udaya S.Tantry Paul A.Gurbel Jong-Hwa Ahn Hyo-Soo Kim Myung Ho Jeong Yaling Han Sidney C.Smith Jr. Junbo Ge | 2019 | Science Bulletin2019，64，3： | 12 |
| 6 | Plasma miR-142 predicts major adverse cardiovascular events as an intermediate biomarker of dual antiplatelet therapy显示文摘MicroRNAs (miRNAs) are widely expressed in organisms and are implicated in the regulation of most biological functions. The present study investigated the association of plasma miRNAs with the clinical outcomes of dual antiplatelet therapy in coronary artery disease (CAD) patients who underwent percutaneous coronary intervention (PCI). Plasma miRNA levels were screened using high-throughput Illumina sequencing to evaluate the antiplatelet efficacy of clopidogrel and aspirin. Six plasma miRNAs (miR-126, miR-130a, miR-27a, miR-106a, miR-21, and miR-142) were associated with clopidogrel-treated platelet aggregation. These miRNAs were validated in a prospective cohort of 1230 CAD patients using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). High plasma miR-142 levels were associated with a high risk of major adverse cardiovascular events (MACE), with a hazard ratio (95% confidence interval) of 1.83 (1.30–2.59) at a false discovery rate of <5%. Multivariable Cox regression analysis revealed that diabetes mellitus, heart failure, calcium channel blocker application, and a high plasma miR-142 level were independent risk factors of MACE. The levels of the six plasma miRNAs were not significantly associated with bleeding events during the 3-year follow-up. In conclusion, plasma miR-142 is potential marker to predict MACE in CAD patients after PCI. | Qian-jie Tang He-ping Lei Hong Wu Ji-yan Chen Chun-yu Deng Wang-sheng Sheng Yong-heng Fu Xiao-hong Li Yu-bi Lin Ya-ling Han Shi-long Zhong | 2019 | Acta Pharmacologica Sinica2019，40，2： | 6 |
| 7 | Feasibility of gastric endoscopic submucosal dissection with continuous low-dose aspirin for patients receiving dual antiplatelet therapy显示文摘BACKGROUND Endoscopic submucosal dissection(ESD) for gastric neoplasms during continuous low-dose aspirin(LDA) administration is generally acceptable according to recent guidelines. This retrospective study aimed to investigate the effect of continuous LDA on the postoperative bleeding after gastric ESD in patients receiving dual antiplatelet therapy(DAPT).AIM To investigate the feasibility of gastric ESD with continuous LDA in patients with DAPT.METHODS A total of 597 patients with gastric neoplasms treated with ESD between January2010 and June 2017 were enrolled. The patients were categorized according to type of antiplatelet therapy(APT).RESULTS The postoperative bleeding rate was 6.9%(41/597) in all patients. Patients were divided into the following two groups: no APT(n = 443) and APT(n = 154). APT included single-LDA(n = 95) and DAPT(LDA plus clopidogrel, n = 59)subgroups. In the single-LDA and DAPT subgroups, 56 and 39 patients were received continuous LDA, respectively. The bleeding rate with continuous singleLDA(10.7%) was similar to that with discontinuous single-LDA(10.3%)(P >0.99). Although the bleeding rate with continuous LDA in patients receiving DAPT(23.1%) was higher than that with discontinuous LDA in patients receiving DAPT(5.0%), no significant difference was observed(P = 0.141).CONCLUSION The bleeding rate with continuous LDA in patients receiving DAPT was not statistically different from that with discontinuous LDA in patients receiving DAPT. Therefore, continuous LDA administration may be acceptable for ESD in patients receiving DAPT, although patients should be carefully monitored for possible bleeding. | Hideaki Harada Satoshi Suehiro Daisuke Murakami Ryotaro Nakahara Takuya Nagasaka Tetsuro Ujihara Ryota Sagami Yasushi Katsuyama Kenji Hayasaka Yuji Amano | 2019 | World Journal of Gastroenterology2019，25，4： | 6 |
| 8 | Bleeding risk assessment in elderly patients with acute coronary syndrome显示文摘Nowadays,elderly people represent a growing population segment with a well known increased risk of both ischemic and bleeding events.Current acute coronary syndrome guidelines,strongly recommend dual antiplatelet therapy(DAPT)with few specific references for aged patients due to lack of evidence.Patients aged>75 years are misrepresented in the classic derivation trials cohorts.Strategies to reduce the bleeding risk in this group of patients are urgently needed for the daily clinical practice.Identify the specific age related bleeding risk factors and the importance of an integral geriatric assessment remains challenging.Some of the available in-hospital and out-hospital bleeding risk scores have shown a lower to moderate predictive ability in older patients and no specific tools are developed in elderly population.The importance of an appropriate vascular access choice,type and duration of antiplatelet drugs is crucial to reduce the bleeding risk.Increase radial approaches and short DAPT duration leads to reduce hemorrhages.One interesting subgroup of patients is those who need chronic anticoagulation therapy after percutaneous coronary intervention,due to their very high risk of bleeding.New alternatives as dual therapy with oral anticoagulation and only one antiplatlet drug should be considered.In current review,we evaluate the available evidence about bleeding risk in elderly. | Lucía Riobóo-Lestón Sergio Raposeiras-Roubin Emad Abu-Assi Andrés I?iguez-Romo | 2019 | Journal of Geriatric Cardiology2019，16，2： | 6 |
| 9 | The pyrrolidinoindoline alkaloid Psm2 inhibits platelet aggregation and thrombus formation by affecting PI3K/Akt signaling显示文摘瞄准:Psm2,从整个 Selaginella moellendorffii 孤立的 pyrrolidinoindoline 碱之一种,显示出一项有势力 antiplatelet 活动。在这研究,我们进一步评估了 Psm2 的 antiplatelet 效果,并且阐明内在的 mechanisms.Methods:在 vitro 和老鼠血小板聚集前 vivo 的人的血小板聚集被调查。导致收缩筋的血小板聚集用轻传播 aggregometer 被测量。Psm2 的 antithrombotic 效果在老鼠在动静脉的分流血栓模型被评估。为了阐明,位于 Psm2, ELISA,西方的弄污并且分子的停靠的 antiplatelet 活动下面的机制被执行。Psm2 管理的流血风险在切模型的一条老鼠尾巴被估计,并且 Psm2 的 cytotoxicity 在 EA.hy926 cells.Results 与 MTT 试金被测量:Psm2 dose-dependently 禁止了自动数据处理, U4619,凝血酵素和骨胶原分别地与 0.64, 0.37, 0.35 和 0.87 mg/mL 的 IC50 价值导致的人的血小板聚集。Psm2 (1, 3, 10 mg/kg ) 予显著地禁止的老鼠以前 vivo 由自动数据处理导致了的血小板聚集。Psm2 (1, 3, 10 mg/mL, iv ) dose-dependently 与 A-V 分流予老鼠以减少血栓形成。分别地, Psm2 与 84.5 和 96.5 mg/mL 的 IC50 价值禁止了血小板粘附到纤维蛋白原和骨胶原但是没影响纤维蛋白原的绑定到 GPIIb/IIIa。而且, Psm2 禁止了 AktSer473 phosphorylation,但是没影响 MAPK 发信号和 Src kinase 激活。分子的停靠证明 Psm2 跳了到 phosphatidylinositol 3-kinase β(PI3Kβ) 与 − 的一个有约束力的免费精力; 13.265 kcal/mol。另外, Psm2 没在房间并且在一只老鼠的生产仅仅细微的流血跟踪切 model.Conclusion 的 EA.hy926 引起毒性:Psm2 由影响 PI3K/Akt 发信号禁止血小板聚集和血栓形成。Psm2 可以是能为 thrombotic 疾病的预防或治疗被开发的铅混合物或药候选人。 | Xing-li SU Wen SU Ying WANG Yue-hu WANG Xin MING Yi KONG | 2016 | Acta Pharmacologica Sinica2016，37，9： | 5 |
| 10 | Clinical evidence of interaction between clopidogrel and proton pump inhibitors显示文摘Clopidogrel is approved for reduction of atherothrombotic events in patients with cardiovascular(CV)and cerebrovascular disease.Dual antiplatelet therapy with aspirin and clopidogrel decreases the risk of major adverse cardiac events after acute coronary syndrome or percutaneous coronary intervention,compared with aspirin alone.Due to concern about gastrointestinal bleeding in patients who are receiving clopidogrel and aspirin therapy,current guidelines recommend combined use of a proton pump inhibitor(PPI)to decrease the risk of bleeding.Data from previous pharmacological studies have shown that PPIs,which are extensively metabolized by the cytochrome system,may decrease the ADP-induced platelet aggregation of clopidogrel. Results from retrospective cohort studies have shown a higher incidence of major CV events in patients re-ceiving both clopidogrel and PPIs than in those without PPIs.However,other retrospective analyses of randomized clinical trials have not shown that the concomitant PPI administration is associated with increased CV events among clopidogrel users.These controversial results suggest that large specific studies are needed. This article reviews the metabolism of clopidogrel and PPIs,existing clinical data regarding the interaction between clopidogrel and PPIs,and tries to provide recommendations for health care professionals. | Shoa-Lin Lin Jaw-Wen Chan | 2011 | World Journal of Cardiology2011，3，5： | 4 |
| 11 | Effect of early surgery in high surgical risk geriatric patients with femoral neck fracture and taking antiplatelet agents显示文摘AIM: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture(FNF) and taking concomitant antiplatelet agents. METHODS: Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery(ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics(45 cases) who had delayed surgery(DS group) after 72 h during an earlier 3-year period. Postoperative outcomeswere followed for one year and compared. RESULTS: There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality(P > 0.05 all). There were 2 patients(4%) in the DS group who died after surgery(P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome(P < 0.05 all).CONCLUSION: Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients. | Paphon Sa-ngasoongsong Noratep Kulachote Norachart Sirisreetreerux Pongsthorn Chanplakorn Sukij Laohajaroensombat Nithiwut Pinsiranon Patarawan Woratanarat Viroj Kawinwonggowit Chanyut Suphachatwong Wiwat Wajanavisit | 2015 | World Journal of Orthopedics2015，6，11： | 4 |
| 12 | Antiplatelet therapy in very elderly and comorbid patients with acute coronary syndromes显示文摘With population ageing and rise of life expectancy,a progressively increasing proportion of patients presenting with an acute coronary syndrome(ACS)are older adults,including those at extreme chronological age.Increasing amounts of data,including randomized clinical trials,have shown that the benefits of an early revascularization are maintained also at very old age,resulting in improved outcome after an acute coronary event.On the contrary,the optimal antiplatelet therapy(APT)remains unclear in these patients,because of both safety and efficacy concerns.Indeed,age-related multiple organ dysfunction and high prevalence of comorbidities may on the one hand reduce the therapeutic effects of administered drugs;on the other hand,it leads to increased vulnerability to drug toxicity and side effects.Therefore,management of APT is particularly challenging in elderly patients because of higher risk of both ischemic and bleeding events.The aim of the present paper is to review the current evidence,gaps in knowledge and ongoing research regarding APT in the setting of an ACS in elderly and very elderly patients,and in those with significant comorbidities including chronic kidney disease,diabetes mellitus and frailty. | Roberta De Rosa Federico Piscione Gennaro Galasso Stefano De Servi Stefano Savonitto | 2019 | Journal of Geriatric Cardiology2019，16，2： | 4 |
| 13 | Inequalities in care in patients with acute myocardial infarction显示文摘Coronary heart disease is the single largest cause of death in developed countries. Guidelines exist for the management of acute myocardial infarction(AMI),yet despite these,significant inequalities exist in the care of these patients. The elderly,deprived socioeconomic groups,females and non-caucasians are the patient populations where practice tends to deviate more frequently from the evidence base. Elderly patients often had higher mortality rates after having an AMI compared to younger patients. They also tended to present with symptoms that were not entirely consistent with an AMI,thus partially contributing to the inequalities in care that is seen between younger and older patients. Furthermore the lack of guidelines in the elderly age group presenting with AMI can often make decision making challenging and may account for the discrepancies in care that are prevalent between younger and older patients. Other patients such as those from a lower socioeconomic group,i.e.,low income and less than high school education often had poorer health and reduced life expectancy compared to patients from a higher socioeconomic group after an AMI. Lower socioeconomic status was also seen to be contributing to racial and geographical variation is the care in AMI patients. Females with an AMI were treated less aggressively and had poorer outcomes when compared to males. However even when females were treated in the same way they continued to have higher in hospital mortality which suggests that gender may well account for differences in outcomes. The purpose of this review is to identify the inequalities in care for patients who present with an AMI and explore potential reasons for why these occur. Greater attention to the management and a better understanding of the root causes of these inequalities in care may help to reduce morbidity and mortality rates associated with AMI. | Shabnam Rashid Alexander Simms Phillip Batin John Kurian Chris P Gale | 2015 | World Journal of Cardiology2015，7，12： | 4 |
| 14 | State of the art contemporary treatment of patients with ST elevationmyocardial infarction: pre- and in-hospital organization, devices anddrugs显示文摘Objective To review the presentation, diagnosis and recent developments in the pharmacological and invasive treatmentof ST elevation myocardial infarction (STEMI) with a special focus on health-care organization in order to increaseaccessibility of primary percutaneous coronary intervention (PCI). | | 2014 | Chinese Medical Journal2014，，6： | 4 |
| 15 | Optimizing the Duration of Dual Antiplatelet Therapy After Implantation of Drug-eluting Coronary Stents显示文摘Percutaneous coronary intervention (PCI) with implantation of drug-eluting stents (DESs) has become the standard of care for coronary artery disease and gives a great impetus to device industry. In 2013, approximately half million patients with coronary artery disease underwent PCI in China with a penetration rate of DES reaching beyond 95%.131 The use of DES including domestic ones is highly effective in preventing coronary restenosis, but there is a collateral cost to be borne in terms of delayed healing or re-endothelialization of the stented arterial segment and risk of stent thrombosisJ41 Therefore. | Ying Shen Wei-Feng Shen | 2015 | Chinese Medical Journal2015，，6： | 4 |
| 16 | Who benefits from percutaneous closure of patent foramen ovale vs medical therapy for stroke prevention? In-depth and updated metaanalysis of randomized trials显示文摘BACKGROUND A few randomized clinical trials(RCT) and their meta-analyses have found patent foramen ovale closure(PFOC) to be beneficial in prevention of stroke compared to medical therapy. Whether the benefit is extended across all groups of patients remains unclear.AIM To evaluate the efficacy and safety of PFOC vs medical therapy in different groups of patients presenting with stroke, we performed this meta-analysis of RCTs.METHODS Electronic search of PubMed, EMBASE, Cochrane Central, CINAHL and ProQuest Central and manual search were performed from inception through September 2018 for RCTs. Ischemic stroke(IS), transient ischemic attack(TIA), a composite of IS, TIA and systemic embolism(SE), mortality, major bleeding,atrial fibrillation(AF) and procedural complications were the major outcomes.Random-effects model was used to perform analyses.RESULTS Meta-analysis of 6 RCTs including 3560 patients showed that the PFOC,compared to medical therapy reduced the risk of IS [odds ratio: 0.34; 95%confidence interval: 0.15-0.78; P = 0.01] and the composite of IS, TIA and SE [0.55(0.32-0.93); P = 0.02] and increased the AF risk [4.79(2.35-9.77); P < 0.0001]. No statistical difference was observed in the risk of TIA [0.86(0.54-1.38); P = 0.54],mortality [0.74(0.28-1.93); P = 0.53] and major bleeding [0.81(0.42-1.56); P = 0.53]between two strategies. Subgroup analyses showed that compared to medical therapy, PFOC reduced the risk of stroke in persons who were males, ≤ 45 years of age and had large shunt or atrial septal aneurysm.CONCLUSION In certain groups of patients presenting with stroke, PFOC is beneficial in preventing future stroke compared to medical therapy. | Khagendra Dahal Adil Yousuf Hussam Watti Brannen Liang Sharan Sharma Jharendra Rijal Pavan Katikaneni Kalgi Modi Neeraj TANDon Michael Azrin Juyong Lee | 2019 | World Journal of Cardiology2019，11，4： | 4 |
| 17 | Risk of bleeding in patients with continued dual antiplatelet therapy during orthopedic surgery显示文摘Background:To prevent risk of life-threatening stent thrombosis,all patients need to undergo dual antiplatelet therapy(DAPT)for at least 6 weeks to 12 months after stent implantation.If DAPT is continued during noncardiac surgery,there is a risk of severe bleeding at the surgical site.Our study was to assess the risk of bleeding in patients with continued DAPT during orthopedic surgery.Methods:The clinical data of 78 patients with coronary heart disease who underwent orthopedic surgery from February 2006 to July 2018 were retrospectively analyzed.Prior to orthopedic surgery,DAPT was continued in 16 patients(groupⅠ),24 patients were treated with single antiplatelet therapy(groupⅡ),and 26 patients received low-molecular-weight heparin therapy for more than 5 days after the discontinuation ofall antiplatelet therapies(groupⅢ).Twelve patients were excluded,as they had undergone minimally invasive surgery such as transforaminal endoscopy and vertebroplasty.The perioperative blood loss of each patient was calculated using Nadler's formula and Gross5 formula.The intraoperative bleeding volume,total volume of intraoperative bleeding in addition to postoperative drainage,and total blood loss were compared between groups.The level of significance was set at P<0.05.Results:There were no significant differences between the three groups in age,intraoperative bleeding volume,total volume of intraoperative bleeding in addition to postoperative drainage,and total perioperative blood loss calculated by Nadler's formula and Gross,formula(all P>0.05).Six patients experienced postoperative cardiovascular complications due to the delayed restart of antiplatelet therapy;one of these patients in group III died from myocardial infarction.Conclusions:Continued DAPT or single antiplatelet treatment during orthopedic surgery does not increase the total intraoperative and perioperative bleeding compared with switching from antiplatelet therapy to low-molecular-weight heparin.However,the discontinuation of antiplatelet therapy increases the risk of serious cardiac complications. | San-Bao Hu Yong Hai Jie-Fu Tang Tao Liu Bing-Xin Liang Bo-Qiong Xue | 2019 | Chinese Medical Journal2019，，8： | 3 |
| 18 | Inhibition of ADP-induced platelet aggregation and involvement of non-cellular blood chemical mediators are responsible for the antithrombotic potential of the fruits of Lagenaria siceraria显示文摘AIM: The fruits of Lagenaria siceraria(Molina) Standl.(Cucurbitaceae), a commonly used vegetable, are reported to possess various medicinal properties. In previous studies, the fibrinolytic potential of an ethanolic extract of fruits of Lagenaria siceraria was investigated in comparison with kaempferol isolated from it. The aim of the present study was to explore its mechanistic antithrombotic potential and antiplatelet activity using a wide dose range in different in vitro and in vivo models, and to quantify the total phenolic, flavonoid, and kaempferol contents using a colorimetric method. METHOD: The antithrombotic potential was investigated using tail bleeding time in mice, a plasma recalcification assay, and pulmonary thromboembolism in mice. The antiplatelet activity was studied using an in vitro model to investigate IC50 value. RESULTS: A significant amount of total phenols, flavonoids, and kaempferol was quantified in L. siceraria ethanolic extract. An ethanolic extract of the fruits of L. siceraria showed a significant increase in tail bleeding time and plasma recalcification time, significant protection against ADP induced pulmonary thromboembolism in mice, and also inhibited the platelet aggregation induced by ADP in vitro. The study suggested that the fruits of L. siceraria exhibit significant antithrombotic potential due to inhibition of ADP-mediated platelet aggregation and the involvement of various non-cellular chemical mediators of blood. CONCLUSION: This finding may be helpful in treating the serious consequences of the thrombus formed in blood vessels which include atherothrombotic diseases, such as myocardial or cerebral infarction. So, further investigation should be done for revealing exact mechanism of action behind these types of activities. | Mithun Singh Rajput Neelam Balekar Dinesh Kumar Jain | 2014 | Chinese Journal of Natural Medicines2014，12，8： | 2 |
| 19 | Neolignans from Selaginella moellendorffii显示文摘Two new neolignans selaginellol(1)and selaginellol 4'-O-β-D-glucopyranoside(2),together with seven known compounds(3–9),were isolated from the whole plant of Selaginella moellendorffii.The structures of the new isolates were determined through spectroscopic data analysis.Compounds 1–9,as well as compounds 10–18 previously isolated from the species,were measured for the activity against platelet aggregation induced by ADP or collagen.Three neoligans(8,11,and 12),one flavanone(14),and one alkaloid(16)showed inhibitory activity against ADP-or collagen-induced platelet aggregation as compared with tirofiban.The dihydrobenzofuran neolignans(8,11,and 12)are more potent than the benzofuran neolignan(13)and other types of neolignans(1–7).Glucosidation of the dihydrobenzofuran neolignans(11 and 12)is helpful for the activity.Graphical Abstract Two new neolignans selaginellol(1)and selaginellol 40-O-b-D-glucopyranoside(2)were isolated from the whole plant of Selaginella moellendorffii.Several compounds from this plant showed the activity against platelet aggregation induced by ADP or collagen. | Jing-Xian Zhuo Yue-Hu Wang Xing-Li Su Ren-Qiang Mei Jun Yang Yi Kong Chun-Lin Long | 2016 | Natural Products and Bioprospecting2016，6，3： | 2 |
| 20 | Clinical problems with antithrombotic therapy for endoscopic submucosal dissection for gastric neoplasms显示文摘Endoscopic submucosal dissection(ESD) is minimally invasive and thus has become a widely accepted treatment for gastric neoplasms,particularly for patients with comorbidities.Antithrombotic agents are used to prevent thrombotic events in patients with comorbidities such as cardio-cerebrovascular diseases and atrial fibrillation.With appropriate cessation,antithrombotic therapy does not increase delayed bleeding in low thrombosis-risk patients.However,high thrombosisrisk patients are often treated with combination therapy with antithrombotic agents and occasionally require the continuation of antithrombotic agents or heparin bridge therapy(HBT) in the perioperative period.Dual antiplatelet therapy(DAPT),a representative combination therapy,is frequently used after placement of drug-eluting stents and has a high risk of delayed bleeding.In patients receiving DAPT,gastric ESD may be postponed until DAPT is no longer required.HBT is often required for patients treated with anticoagulants and has an extremely high bleeding risk.The continuous use of warfarin or direct oral anticoagulants may be possible alternatives.Here,we show that some antithrombotic therapies in high thrombosis-risk patients increase delayed bleeding after gastric ESD,whereas most antithrombotic therapies do not.The management of high thrombosis-risk patients is crucial for improved outcomes. | Toshiyuki Yoshio Tsutomu Nishida Yoshito Hayashi Hideki Iijima Masahiko Tsujii Junko Fujisaki Tetsuo Takehara | 2016 | World Journal of Gastrointestinal Endoscopy2016，8，20： | 2 |
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