The Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) study investigated the use of clopidogrel in the treatment of acute coronary syndromes. Clopidogrel treatment led to an impressive 20% relative ris...
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The Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) study investigated the use of clopidogrel in the treatment of acute coronary syndromes. Clopidogrel treatment led to an impressive 20% relative risk reduction in the composite outcome measure of vascular death, myocardial infarction, and stroke. Increased bleeding and greater requirements for blood transfusions were seen with clopidogrel. The addition-of clopidogrel to aspirin represents a major advance in the treatment of acute coronary syndromes.
OBJECTIVES We sought to evaluate immediate and late outcomes after stenting for left main coronary artery (LMCA) stenosis. BACKGROUND Conventional percutaneous transluminal coronary angioplasty (PTCA), for which coron...
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OBJECTIVES We sought to evaluate immediate and late outcomes after stenting for left main coronary artery (LMCA) stenosis. BACKGROUND Conventional percutaneous transluminal coronary angioplasty (PTCA), for which coronary artery bypass grafting (CABG) has been the gold standard therapy for years, has yielded poor results in unprotected LMCA lesions. The development of coronary stents, together with their dramatic patency improvement provided by new antiplatelet regimens and their validation against restenosis, warrants a reappraisal of angioplasty in LMCA stenosis. METHODS From January 1993 to September 1998, 140 consecutive unselected patients with unprotected LMCA stenosis underwent elective stenting. Group I included 47 high-CABG-risk patients, and group II included 93 low-CABG-risk patients. Ticlopidine without aspirin was routinely started at least 72 h before the procedure and continued for one month. Patients were reevaluated monthly. A follow-up angiography was requested after six months. RESULTS The procedure success rate was 100%. One-month mortality was 9% (4/47) in group I and 0% in group II. A follow-up angiography nas obtained in 82% of cases, and target lesion revascularization was required in 17.4%. One-year actuarial survival was 89% in the first 29 group I patients and 97.5% in the first 63 group IT patients. CONCLUSIONS Stenting of unprotected LMCA stenosis provided excellent immediate results, particularly in good CABG candidates. Medium-term results were good, with a restenosis rate of 23%, similar to that seen after stenting at other coronary sites. Stenting deserves to be considered a safe and effective alternative to CABG in institutions performing large numbers of PTCAs. (C) 2000 by the American College of Cardiology.
The role of neutrophils in psoriasis has long been discussed. We report a patient with long-standing psoriasis vulgaris who showed rapid improvement during agranulocytosis caused by ticlopidine. The patient did not de...
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The role of neutrophils in psoriasis has long been discussed. We report a patient with long-standing psoriasis vulgaris who showed rapid improvement during agranulocytosis caused by ticlopidine. The patient did not develop any new psoriatic lesions for several days, although neutrophils increased daily after the administration of ticlopidine was stopped. The day after the peripheral blood neutrophil count recovered, several psoriatic plaques reappeared. The correlation of psoriatic activity with peripheral blood neutrophil counts suggests that a certain number of neutrophils may be required to initiate and maintain psoriasis.
A prospective study was carried out to assess the occurrence and character of adverse cutaneous reactions in patients receiving ticlopidine hydrochloride to prevent subacute thrombosis after having undergone placement...
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A prospective study was carried out to assess the occurrence and character of adverse cutaneous reactions in patients receiving ticlopidine hydrochloride to prevent subacute thrombosis after having undergone placement of coronary stents. During a 1-year period such patients were requested to report adverse cutaneous reactions, and those with skin reactions were referred for dermatological evaluation. Among the 136 patients who underwent stent placement by one of the authors, 20 were referred for dermatological evaluation. Of these, 16 (11.8%) fit the case definition of ticlopidine-associated cutaneous reactions. In the first 8 consecutive patients ticlopidine was withdrawn (in 2 of these a rechallenge test as later performed);in the next 8 patients ticlopidine was not discontinued before completion of the intended week period of treatment. Patients remained under weekly follow-up and underwent a weekly blood count. Skin biopsies n;ere obtained in 5 patients with different types of eruptions. The skin reactions appeared from 2 to 21 days after commencement of ticlopidine (mean, 10 days), lasting from 2 to 30 days (mean, 5 days). Onlly 3 patients had other adverse effects: neutropenia in 1 and abdominal pain and nausea in 2. The most common presentations were urticaria, pruritus. and maculopapular eruption. In 3 patients there were previously unreported reactions: fixed drug eruption, erythromelalgia-like eruption, and erythema multiforme-like eruption. Of note was the rapid clearing of the skin eruption in most cases even a-hen the drug was not withdrawn. It was concluded that adverse cutaneous reactions are relatively common in association with ticlopidine treatment but that serious reactions are rare and the disappearance of the signs and symptoms is rapid. suggesting that discontinuation of the drug is not usually imperative.
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