Biomedical subjects

Deepak L Bhatt

Publications and source records attributed to Deepak L Bhatt.

134 records · Page 8Linked to original sources

PubMed2002

The efficacy and safety of perioperative antiplatelet therapy.

Widespread adoption of the antiplatelet agents into everyday clinical practice has revolutionized contemporary care of the cardiovascular patient. Major adverse cardiovascular events including death, myocardial infarction, stroke, and recurrent angina have all been shown to be significantly decreased when these agents are employed in the treatment of coronary atherosclerosis, acute coronary syndromes, myocardial infarction, and in the setting of percutaneous coronary intervention. As a growing number of patients on antiplatelet therapy are undergoing various surgical procedures, the potential risks and benefits these drugs pose perioperatively will become increasingly important. Available data indicate that, when used appropriately, these drugs can be used safely prior to surgery. Efficacy in improving surgical outcomes and in preventing adverse cardiovascular events postoperatively has also been demonstrated. The purpose of this review is to examine the perioperative safety and efficacy of the most widely used antiplatelet agents: aspirin; the thienopyridine clopidogrel; and the glycoprotein (GP) IIb/IIIa inhibitors abciximab, eptifibatide, and tirofiban. This information, coupled with emerging platelet monitoring techniques, may help provide additional assistance to the clinician to manage therapy and guide appropriate timing of both cardiac and noncardiac surgery.

Cardiovascular Diseases↗

PubMed2002

Antiplatelet therapies in combination for the treatment of patients with stable and unstable coronary artery disease.

There have been several recent trials of antiplatelet therapy that are relevant to the management of patients with coronary artery disease. The CURE, PCI-CURE, ESPRIT, TACTICS-TIMI 18, and TARGET studies were all major randomized clinical trials that have advanced the field of cardiovascular medicine tremendously. Additionally, the CREDO trial will soon be presented. It is evident from these trials that clopidogrel therapy improves upon the results seen with aspirin alone in patients with acute coronary syndromes. This is true even of patients undergoing an invasive approach, which is clearly the preferred strategy in moderate and high risk patients with acute coronary syndromes. It is imperative that this invasive approach be coupled with intravenous blockade of the glycoprotein IIb/IIIa receptor. The benefits of clopidogrel and glycoprotein IIb/IIIa inhibitors appear complementary. Questions remain about the optimal duration of clopidogrel treatment after elective stenting and of the particular choice of glycoprotein IIb/IIIa inhibitor both in acute and elective settings.

Coronary Artery Disease↗

PubMed2002

Percutaneous treatment for pacemaker-associated superior vena cava syndrome.

Superior vena cava (SVC) obstruction is an uncommon but serious complication associated with permanent pacemaker implantation. The mechanical stress associated with pacemaker wires may lead to vessel wall inflammation, fibrosis, and thrombus formation, and ultimately to venous stenosis and occlusion. The surgical treatment of pacemaker related SVC syndrome requires thoracotomy and carries significant morbidity. This article illustrates the authors' initial experience with a "one-step" percutaneous approach for this problem, consisting of percutaneous retrieval of a pacemaker system, followed by venous revascularization with angioplasty and stenting, and installation of a new pacemaker device.

Adult↗

PubMed2002

The CURE trial: using clopidogrel in acute coronary syndromes without ST-segment elevation.

In a large, randomized, placebo-controlled trial in centers that use a conservative approach to acute coronary syndromes, the antiplatelet drug clopidogrel (Plavix) decreased the rate of the combined end point of cardiovascular death, nonfatal myocardial infarction, or stroke by 20% in patients presenting with acute coronary syndromes without ST-segment elevation. The benefit was at the cost of an increase in bleeding, however. This strategy may need to be tailored in centers that use a more aggressive treatment strategy of early angiography and revascularization.

Angina Pectoris↗

PubMed2002

Why diabetics are at risk in percutaneous coronary intervention and the appropriate management of diabetics in interventional cardiology.

The increasing prevalence of diabetes mellitus in the U.S., particularly among younger patients, will place significant additional demands on an already strained healthcare delivery system. The metabolic and hormonal milieu created by diabetes mellitus fosters the development of systemic atherosclerosis, and mortality in these patients is driven largely by complications of cardiovascular disease. Unfortunately, diabetic pathophysiology poses unique challenges to attaining successful coronary revascularization, whether it is by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). In determining the optimal treatment strategy for a diabetic patient with coronary atherosclerotic disease, it is imperative that the treating physician fully understands the following: the inherent limitations to revascularization in diabetics, the pharmacologic therapies of proven benefit in diabetics with atherosclerotic disease, the currently available comparative data of CABG versus PCI in diabetics, and the ongoing medical, surgical, and interventional advances which may render earlier data obsolete.

Abciximab↗

PubMed2001

Debate: PCI or CABG for multivessel disease? Viewpoint: No clear winner in an unfair fight.

The Arterial Revascularization Therapy Study (ARTS) and the Stent or Surgery (SoS) trial each randomized patients with multivessel disease to either stenting or bypass surgery. The ARTS showed no difference in mortality between the two strategies, other than in diabetic patients, who fared better with surgery. The SoS trial demonstrated increased mortality in the stent arm, a difference that was not attributable to diabetes. Both trials found that the rates of repeat revascularization were lower with surgery, although the rate with stenting was much lower than had been seen in previous trials of angioplasty. Use of antiplatelet therapy such as intravenous glycoprotein IIb/IIIa inhibitors, especially with their pronounced effects in diabetics and in those with multivessel disease, could potentially equalize the playing field or perhaps even tip the balance in favor of percutaneous intervention.

Journal Article↗

PubMedDate not supplied

Clinical outcomes in metabolic syndrome.

Metabolic syndrome is a clustering of cardiovascular risk factors. Its definition is the presence of any 3 of the following: obesity, hypertriglyceridemia, low high-density lipoprotein, hypertension, and impaired fasting glucose. The development of coronary artery disease is the most dreaded complication of this disease. In the United States, Mexican Americans and African American women are the most affected. Management of this syndrome includes physical exercise, weight loss, and effective drug treatment of dyslipidemia, high blood pressure, and impaired fasting blood glucose. Because of the increasing prevalence of obesity and diabetes, there is a rise in fatal and nonfatal cardiovascular events. With the development of effective antiplatelet medication and newer drug-eluting stents, percutaneous coronary intervention has become an effective revascularization strategy for those with coronary artery disease. Rates of stent restenosis and target-lesion revascularization have been reduced. Oral hypoglycemic drugs like thiazolidinediones improve insulin resistance and may have a favorable effect in those with metabolic syndrome. Diagnosis and appropriate management of metabolic syndrome are challenges as the presence of risk factors predates the coronary event.

C-Reactive Protein↗

PubMedDate not supplied

Highlights of the 2002 update to the 2000 American College of Cardiology/American Heart Association acute coronary syndrome guidelines.

Since the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for acute coronary syndrome (ACS) were published in 2000, a wealth of clinical evidence has accumulated. To incorporate this recent clinical data, an update to the 2000 ACC/AHA guidelines was issued in 2002. The revised ACC/AHA guidelines emphasize risk stratification of ACS patients to help guide therapy. In antiplatelet therapy, clopidogrel has gained a more prominent role in the treatment of ACS, both in breadth of patients and duration of treatment. Ticlopidine is no longer recommended. More guidance is provided with respect to specific glycoprotein IIb/IIIa inhibitor use in subgroups of ACS patients. In anticoagulation therapy, enoxaparin is now favored over unfractionated heparin. Finally, class I indications for an early invasive strategy have been expanded to include patients with elevated cardiac markers or new ST segment depression. Early initiation and continuation of a hepatic hydroxymethyl glutaryl coenzyme A reductase inhibitor is recommended if low-density lipoprotein cholesterol is higher than 100 mg/dL, and the addition of niacin or a fibrate is recommended in patients with isolated low high-density lipoprotein cholesterol. This article summarizes the major modifications to the ACS guidelines and highlights the clinical evidence prompting such changes.

Acute Disease↗