240 research outputs found
An Exploration of a Blended Learning Cohort Through Social Network Analysis
The following technical report is a social network analysis of online threaded discussions from three blending learning cohorts. The purpose of this social network analysis was to explore graduate level blended learning cohorts by investigating how the relationships and interactions among individuals shape and affect the overall cohort,to explore the evolution of each cohort overtime,and to investigate facilitator interactions within the blended learning program and how their contributions shaped and affected the network.
The threaded discussions were coded and analyzed based on literature about social network analysis, constructive-developmental theory, holding environments, and transformational learning theory. Eight selected weeks of discussions were coded for each of the three cohorts. All three cohorts remained mostly consistent with the same individuals and the same facilitators throughout the year-long program. The stability of the participants and the facilitatorsgeneratedsocialnetworkoutcomesfromallfourquartersofeachcohort. In order to confirm the results of the hypothesis of this researcher about constructive-developmentalism and transformational learning within these cohorts, the researcher then cross-referenced with the analysis of another researcher using the same data who conducted a content analysis in ways of knowing. Discussion of the analysis and further recommendations for research has been included in this report
EFFECT OF TICAGRELOR VERSUS CLOPIDOGREL ON HIGH PLATELET REACTIVITY DURING MAINTENANCE THERAPY
Increased Risk in Patients With High Platelet Aggregation Receiving Chronic Clopidogrel Therapy Undergoing Percutaneous Coronary Intervention Is the Current Antiplatelet Therapy Adequate?
ObjectivesWe sought to determine whether patients receiving chronic clopidogrel therapy undergoing nonemergent stenting who display high on-treatment preprocedural platelet aggregation measured by standard light transmittance aggregometry and thrombelastography (TEG) will be at increased risk for poststenting ischemic events.BackgroundPatients exhibiting heightened platelet reactivity to adenosine diphosphate (ADP) might be at increased risk for recurrent ischemic events after coronary stenting.MethodsA total of 100 consecutive patients receiving chronic antiplatelet therapy consisting of aspirin (325 mg qd) and clopidogrel (75 mg qd) were studied before undergoing nonemergent stenting. Patients were followed for 1 year after coronary stenting for the occurrence of death, myocardial infarction, stent thrombosis, stroke, or ischemia requiring a hospital stay.ResultsAll patients were aspirin responsive. Patients with ischemic events (23 of 100, 23%) within 1 year had greater on-treatment prestent ADP-induced platelet aggregation than patients without ischemic events by aggregometry and TEG (p < 0.001 for both measurements). Of patients with an ischemic event, 70% and 87% displayed high on-treatment platelet reactivity at baseline by aggregometry and TEG, respectively. High on-treatment platelet reactivity as measured by aggregometry and TEG were the only variables significantly related to ischemic events (p < 0.001 for both assays). The administration of eptifibatide reduced periprocedural elevation in platelet reactivity, with no significant differences in bleeding events.ConclusionsPatients receiving chronic clopidogrel therapy undergoing nonemergent percutaneous coronary intervention who exhibit high on-treatment ADP-induced platelet aggregation are at increased risk for postprocedural ischemic events. These findings might have implications for the alteration in clopidogrel maintenance dose and use of glycoprotein IIb/IIIa inhibitors in selected patients
PAR1 (Protease-Activated Receptor 1) Pepducin Therapy Targeting Myocardial Necrosis in Coronary Artery Disease and Acute Coronary Syndrome Patients Undergoing Cardiac Catheterization: A Randomized, Placebo-Controlled, Phase 2 Study
OBJECTIVE: Arterial thrombosis leading to ischemic injury worsens the prognosis of many patients with cardiovascular disease. PZ-128 is a first-in-class pepducin that reversibly inhibits PAR1 (protease-activated receptor 1) on platelets and other vascular cells by targeting the intracellular surface of the receptor. The TRIP-PCI (Thrombin Receptor Inhibitory Pepducin in Percutaneous Coronary Intervention) trial was conducted to assess the safety and efficacy of PZ-128 in patients undergoing cardiac catheterization with intent to perform percutaneous coronary intervention.
Approach and Results: In this randomized, double-blind, placebo-controlled, phase 2 trial, 100 patients were randomly assigned (2:1) to receive PZ-128 (0.3 or 0.5 mg/kg), or placebo in a 2-hour infusion initiated just before the start of cardiac catheterization, on top of standard oral antiplatelet therapy. Rates of the primary end point of bleeding were not different between the combined PZ-128 doses (1.6%, 1/62) and placebo group (0%, 0/35). The secondary end points of major adverse coronary events at 30 and 90 days did not significantly differ but were numerically lower in the PZ-128 groups (0% and 2% in the PZ-128 groups, 6% and 6% with placebo, p=0.13, p=0.29, respectively). In the subgroup of patients with elevated baseline cardiac troponin I, the exploratory end point of 30-day major adverse coronary events + myocardial injury showed 83% events in the placebo group versus 31% events in the combined PZ-128 drug groups, an adjusted relative risk of 0.14 (95% CI, 0.02-0.75); P=0.02.
CONCLUSIONS: In this first-in-patient experience, PZ-128 added to standard antiplatelet therapy appeared to be safe, well tolerated, and potentially reduced periprocedural myonecrosis, thus providing the basis for further clinical trials.
Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02561000
Acetylsalicylic acid and clopidogrel hyporesponsiveness following acute coronary syndromes
This review discusses the response variability to acetylsalicylic acid (ASA) and particularly to clopidogrel, and their relation to adverse recurrent ischaemic events in patients with arterial diseases. The higher rate of ASA resistance reported in the literature may be mainly due to the cyclooxygenase-1 non-specific assays, non-compliance, and underdosing. Clopidogrel response variability and non-responsiveness are established concepts. Moreover, high platelet reactivity (HPR) to adenosine diphosphate during clopidogrel therapy is now a known risk factor for recurrent ischaemic events in high-risk percutaneous coronary intervention/acute coronary syndrome patients. Variable active metabolite generation is the primary explanation for clopidogrel response variability and non-responsivenes. Variable levels of active metabolite generation following clopidogrel administration could be mainly explained by functional variability in hepatic cytochrome (CYP)P450 isoenzyme activity that is influenced by drug–drug interactions and single nucleotide polymorphisms of specific genes encoding CYP450 isoenzymes. Treatment with more potent P2Y12 receptor blockers, such as prasugrel and ticagrelor are credible alternative strategies to overcome HPR during clopidogrel therapy
Incidence of Dyspnea and Assessment of Cardiac and Pulmonary Function in Patients With Stable Coronary Artery Disease Receiving Ticagrelor, Clopidogrel, or Placebo in the ONSET/OFFSET Study
ObjectivesWe prospectively assessed cardiac and pulmonary function in patients with stable coronary artery disease (CAD) treated with ticagrelor, clopidogrel, or placebo in the ONSET/OFFSET (A Multi-Centre Randomised, Double-Blind, Double-Dummy Parallel Group Study of the Onset and Offset of Antiplatelet Effects of AZD6140 Compared With Clopidogrel and Placebo With Aspirin as Background Therapy in Patients With Stable Coronary Artery Disease) study.BackgroundTicagrelor reduces cardiovascular events more effectively than clopidogrel in patients with acute coronary syndromes. Dyspnea develops in some patients treated with ticagrelor, and it is not known whether this is associated with changes in cardiac or pulmonary function.MethodsIn all, 123 stable aspirin-treated CAD patients randomly received either ticagrelor (180 mg load, then 90 mg twice daily; n = 57), clopidogrel (600 mg load, then 75 mg daily; n = 54), or placebo (n = 12) for 6 weeks in a double-blind, double-dummy design. Electrocardiography, echocardiography, serum N-terminal pro-brain natriuretic peptide, and pulmonary function tests were performed before (baseline) and 6 weeks after drug administration and/or after development of dyspnea.ResultsAfter drug administration, dyspnea was reported by 38.6%, 9.3%, and 8.3% of patients in the ticagrelor, clopidogrel, and placebo groups, respectively (p < 0.001). Most instances were mild and/or lasted <24 h, although 3 patients discontinued ticagrelor because of dyspnea. Eight of 22 and 17 of 22 ticagrelor-treated patients experiencing dyspnea did so within 24 h and 1 week, respectively, after drug administration. In all treatment groups, and in ticagrelor-treated patients with dyspnea, there were no significant changes between baseline and 6 weeks in any of the cardiac or pulmonary function parameters.ConclusionsDyspnea is commonly associated with ticagrelor therapy, but was not associated in this study with any adverse change in cardiac or pulmonary function. (A Multi-Centre Randomised, Double-Blind, Double-Dummy Parallel Group Study of the Onset and Offset of Antiplatelet Effects of AZD6140 Compared With Clopidogrel and Placebo With Aspirin as Background Therapy in Patients With Stable Coronary Artery Disease [ONSET/OFFSET]; NCT00528411
Updated evidence on intracoronary abciximab in ST-elevation myocardial infarction: A systematic review and meta-analysis of randomized clinical trials
Abstract
Background: Intracoronary (IC) abciximab administration remains a promising approach
aimed to increase a drug concentration in the target area and possibly improve clinical
outcomes in the setting of ST-segment elevation myocardial infarction (STEMI). The goal of
this literature review and meta-analysis is to update available knowledge comparing IC and
intravenous (IV) abciximab administration in STEMI patients.
Methods: A total of 7 randomized clinical trials (RCTs) with a median follow-up of 3 months
were included in the meta-analysis (n = 3311). All-cause mortality was selected as the primary
end point while recurrent myocardial infarction (re-MI), target vessel revascularization (TVR)
and major bleeding complications were the secondary end points.
Results: IC abciximab did not provide any benefits in terms of all-cause mortality as compared
with IV abciximab (odds ratio [OR] 0.67; 95% confidence interval [CI] 0.34 1.34). However,
this neutral effect was driven by the AIDA STEMI trial. The IC route was associated with a
reduced rate of re-MI when compared with IV administration (OR 0.61; 95% CI 0.40 0.92)
but the difference disappeared after one of the RCTs was excluded from the analysis. Both
strategies were equal regarding TVR (OR 0.66; 95% CI 0.40 1.09) and major bleeding
complications (OR 1.18; 95% CI 0.76 1.83).
Conclusions: Our updated meta-analysis shows that the clinical superiority of IC over IV
abciximab administration in STEMI patients is no longer clear after the release of the AIDA
STEMI trial results. Further research in high-risk STEMI patients is warranted to finally
determine clinical advantages of IC vs IV abciximab administration. (Cardiol J 2012; 19, 3:230 242
Drug-coated balloons in treatment of in-stent restenosis: a meta-analysis of randomised controlled trials
Background Drug-coated balloons (DCBs) have been
developed for the percutaneous treatment of coronary
artery disease. An initial focus has been the management of
in-stent restenosis (ISR) but randomised controlled trials
(RCTs) have been small and powered only for angiographic
endpoints.
Objective The aim of the work was to assess the clinical
and angiographic outcomes of patients treated for ISR with
DCB versus control (balloon angioplasty or drug-eluting
stents) by a meta-analysis of RCTs.
Methods A comprehensive search was performed of
RCTs where patients with ISR were randomly assigned to
either DCB or alternative coronary intervention. Outcome
measurements were death, myocardial infarction (MI),
target lesion revascularisation (TLR), binary definition of
restenosis and in-lesion late luminal loss (LLL).
Results Four studies were identified that fulfilled the
inclusion criteria. Pooled odds ratios (ORs) were calculated
for patients treated for ISR (n = 399). Mean follow-up
duration was 14.5 months. DCBs were associated with
lower rates of TLR [8.8 vs. 29.7 % OR (95 % confidence
interval, CI) 0.20 (0.11–0.36), p\0.0001], binary restenosis
[10.3 vs. 41.3 % OR (95 % CI) 0.13 (0.07–0.24),
p\0.00001] and MI [0.5 vs. 3.8 %, OR (95 % CI) 0.21
(0.04–1.00), p = 0.05]. No significant heterogeneity was
identified.
Conclusion Drug-coated balloons appear to be effective
versus control in reducing TLR and possibly MI versus
balloon angioplasty or drug-eluting stents in the management
of ISR
Personalizing Antithrombotic Therapy in COVID-19: Role of Thromboelastography and Thromboelastometry
- …