Risk reduction with clopidogrel in the management of peripheral arterial disease

Peripheral arterial disease (PAD) is a condition typified by decreased arterial blood flow in the non-coronary branches of the aorta as a result of chronic atherosclerosis. Despite the higher prevalence of PAD compared with other cardiovascular entities such as myocardial infarction and stroke, far less import is given to its diagnosis and treatment. In this review, we highlight principal diagnostic and therapeutic considerations in the management of PAD and its complications. We particularly emphasize the role of clopidogrel in the reduction of risks associated with PAD

Role of antiplatelet therapy in cardiovascular disease II: Ischemic stroke.

The etiology of cerebrovascular disease is heterogeneous, with the majority of strokes being of ischemic origin. Transient ischemic attack is now considered to be an important precursor and long-term risk factor for ischemic stroke. Given the lack of acute therapies for ischemic stroke, current treatments focus on secondary prevention through risk-factor management, pharmacotherapy and interventional approaches. As illustrated in this paper, antiplatelet agents (e.g. clopidogrel, aspirin, dipyridamole) are the cornerstone of therapy for prevention of recurrent ischemic stroke

Participant Observation as Ethnography or Ethnography as Participant Observation in Organizational Research

There is a strong tradition of observational research in most areas of the social sciences, especially in Anthropology and Sociology. However, in business and management research observation is often seen as a poor relative to questionnaire surveys and qualitative interviewing. This chapter discusses the use of observational techniques especially for less experienced researchers planning their first major investigation, exploring the difference between participant and non-participant approaches, different techniques of data collection, recording and analysis. Rather than seeking to provide a full guide to conducting participant observation, an impractical task in a single chapter, this offering discusses some of the key issues facing researchers in Business and Management who choose to conduct this sort of research, exploring different approaches to participant observation and some of the ethical and practical challenges associated with the collection and analysis of observational data. The chapter draws on the author’s experience of conducting participant observation in organizations with examples of both employee (Sandiford and Seymour, 2002; Seymour and Sandiford, 2013) and customer perspectives (Sandiford and Divers, 2011). It will also draw from ‘classic’ observational studies such as Mars and Nicod (1984) and more recent examples such as Watson and Watson (2012).Peter John Sandifor

Role of antiplatelet therapy in cardiovascular disease II: Ischemic stroke.

The etiology of cerebrovascular disease is heterogeneous, with the majority of strokes being of ischemic origin. Transient ischemic attack is now considered to be an important precursor and long-term risk factor for ischemic stroke. Given the lack of acute therapies for ischemic stroke, current treatments focus on secondary prevention through risk-factor management, pharmacotherapy and interventional approaches. As illustrated in this paper, antiplatelet agents (e.g. clopidogrel, aspirin, dipyridamole) are the cornerstone of therapy for prevention of recurrent ischemic stroke

Elevated Plasma Fibrinogen Level Predicts Suboptimal Response to Therapy With Both Single- and Double-Bolus Eptifibatide During Percutaneous Coronary Intervention

ObjectivesThis study sought to determine the factors associated with suboptimal platelet inhibition (PI) with single- and double-bolus eptifibatide during percutaneous coronary intervention (PCI).BackgroundAlthough PI ≥ 95% measured 10 min after glycoprotein IIb/IIIa inhibitor therapy is associated with improved outcomes following PCI, this level of PI often is not achieved.MethodsWe prospectively studied 150 patients undergoing PCI with single-bolus eptifibatide (180 μg/kg) (n = 100) and double-bolus eptifibatide (180 μg/kg administered 10 min apart) (n = 50) followed by standard infusion (2 μg/kg/min). Measuring platelet aggregation at baseline and at 10 min and 30 to 45 min after eptifibatide bolus, patients were classified as optimal responders (OPT) (≥95% PI) or suboptimal responders (sub-OPT) (<95% PI) based on 10-min PI after final bolus.ResultsSuboptimal PI was achieved in 61% of patients with single-bolus eptifibatide and in 36% with double-bolus eptifibatide. In the single-bolus group, sub-OPT had higher fibrinogen levels (324 ± 85 mg/dl vs. 259 ± 49 mg/dl, p = 0.0002), platelet counts (221 ± 70 vs. 186 ± 47, p = 0.008), and white blood cell counts (7.7 ± 2.3 vs. 6.6 ± 1.9, p = 0.02). In the double-bolus group, sub-OPT also had higher fibrinogen levels (324 ± 68 mg/dl vs. 278 ± 53 mg/dl, p = 0.01) and were more likely to be smokers (38.9% vs. 9.4%, p = 0.01). Multivariable analysis showed that fibrinogen level was the only independent predictor of suboptimal PI, with fibrinogen cutoffs at 375 and 325 mg/dl predicting suboptimal PI (single-bolus: 100% and 90.0%, respectively; double-bolus: 100% and 60%, respectively) with both doses.ConclusionsDuring PCI, both single- and double-bolus eptifibatide provide suboptimal PI in a substantial proportion of patients. A fibrinogen level >375 mg/dl is a strong predictor of suboptimal PI