954 research outputs found

    Tailoring antiplatelet therapy in older patients with coronary artery disease

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    The older population represents a unique subset of patients due to a higher rate of comorbidities and risk factors, which can lead to a higher rate of ischemic and bleeding events. As a result, older adults are mainly underrepresented or excluded from randomized trials. Although the advancement in the percutaneous coronary intervention field with the development of new technologies, techniques, and potent antiplatelet therapy led to a reduction of ischemic risk, there is still a concern regarding bleeding hazards. Apart from the global utilization of less invasive trans-radial approach and proton pump inhibitors to reduce bleeding risk, proper tailoring of antiplatelet therapy in the older person is imperative. So far, several antiplatelet drugs have been introduced in different clinical scenarios, with dual antiplatelet therapy (combination of acetylsalicylic acid and P2Y12 inhibitor) recommended after percutaneous coronary intervention. The decision on the choice of antiplatelet drug and the DAPT duration is challenging and should be based on the relationship between ischemia and bleeding with the purpose of reducing ischemic events but not at the expense of increased bleeding complications. This is particularly important in the older population, where the evidence is obscure. The main objective of this review is to summarize the available evidence on contemporary antiplatelet therapy and different approaches of de-escalation strategies in older patients after percutaneous coronary intervention.What is the context?The older population represents a unique subset of patients due to a higher rate of comorbidities, risk factors, and unfavorable prognostic features, which can lead to a higher rate of ischemic and bleeding events. They are either excluded or underrepresented in most randomized clinical trials, which is why guidelines recommendation should be taken cautiously. Thus, the decision on the choice of antiplatelet therapy and its duration after percutaneous coronary intervention in older adults is challenging and should be tailored to a particular patient to avoid bleeding complications but not at the expense of increased ischemic events.What is new?In this review, we summarize all available evidence on contemporary antiplatelet therapy and different approaches of de-escalation strategies in older patients after percutaneous coronary intervention. In particular, several recommended approaches in patients with high bleeding risk, are thoroughly discussed in this review: De-escalation strategies with discontinuation of one antiplatelet drugDe-escalation strategy with switching between P2Y12 inhibitorsDe-escalation strategy based on dose reductionFinally, based on the current knowledge on factors contributing to high bleeding risk and the aforementioned antiplatelet modification approaches, in this review, we propose antiplatelet algorithm after percutaneous coronary intervention in older adults.What is the impact?The review provides comprehensive knowledge on antiplatelet therapy in older population and may help in tailoring antiplatelet therapy in this unique subset of patients

    Long-term variability of the optical spectra of NGC 4151: II. Evolution of the broad Ha and Hb emission-line profiles

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    Results of the long-term (11 years, from 1996 to 2006) Hα\alpha and Hβ\beta line variations of the active galactic nucleus of NGC 4151 are presented. High quality spectra (S/N>50 and R~8A) of Hα\alpha and Hβ\beta were investigated. We analyzed line profile variations during monitoring period. Comparing the line profiles of Hα\alpha and Hβ\beta, we studied different details (bumps, absorption features) in the line profiles. The variations of the different Hα\alpha and Hβ\beta line profile segments have been investigated. Also, we analyzed the Balmer decrement for whole line and for line segments. We found that the line profiles were strongly changing during the monitoring period, showing blue and red asymmetries. This indicates a complex BLR geometry of NGC 4151 with, at least, three kinematically distinct regions: one that contributes to the blue line wing, one to the line core and one to the red line wing. Such variation can be caused by an accelerating outflow starting very close to the black hole, where the red part may come from the region {closer to the black hole than the blue part, which is coming} from the region having the highest outflow velocities. Taking into account the fact that the BLR of NGC 4151 has a complex geometry (probably affected by an outflow) and that a portion of the broad line emission seems to have not a pure photoionization origin, one can ask the question whether the study of the BLR by reverberation mapping may be valid in the case of this galaxy.Comment: 24 pages, 18 figures, accepted for publications in A&
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