Most studies indicated that low on-treatment platelet reactivity ( LTPR ) , as measured by several platelet function tests , and the carriage of CYP2C19 * 17 allele were independent risk factors for bleeding .
A bleeding score also proved to be helpful in identifying patients at risk .
Several patient characteristics were also identified as independent predictors of bleeding , such as older age , female sex and renal failure .
Patients with coronary artery disease are usually treated with dual antiplatelet therapy ( DAPT ) after percutaneous coronary intervention .
Patients on DAPT are at risk of both ischaemic and bleeding events .
Although side-lined for a long time , real-life studies have shown that both the incidence and the associated morbidity and mortality of out-of-hospital bleeding are high .
This indicates that prevention of ( post-interventional ) bleeding is as important as prevention of ischaemia .
For this purpose it is crucial to reliably identify patients with a high bleeding risk .
In order to postulate an algorithm , which could help identifying these patients , we performed a systematic review to determine the value of previously proposed prognostic modalities for bleeding .
Pharmacodynamics, pharmacokinetics, and safety of the oral reversible P2Y12 antagonist AZD6140 with aspirin in patients with atherosclerosis: a double-blind comparison to clopidogrel with aspirin.
AIMS This double-blind , parallel-group study was conducted to assess the pharmacodynamics , pharmacokinetics , and safety of AZD6140 , the first oral , reversible adenosine diphosphate ( ADP ) receptor antagonist . METHODS AND RESULTS Patients ( n = 200 ) with atherosclerosis were r and omized to receive AZD6140 50 , 100 , or 200 mg twice daily ( bid ) or 400 mg daily ( qd ) or clopidogrel 75 mg qd for 28 days . All groups received aspirin 75 - 100 mg qd . AZD6140 ( 100 and 200 mg bid , 400 mg qd ) rapidly and nearly completely inhibited ADP-induced platelet aggregation after initial dosing ( day 1 ) and at day 28 . On day 1 , peak final-extent inhibition of platelet aggregation ( IPA ) was observed 2 - 4 h post-dose with AZD6140 , whereas clopidogrel minimally inhibited platelet aggregation ( mean percentage IPA < 20 % , all time points ) . Four hour post-dose at steady state , the three higher doses of AZD6140 produced comparable final-extent mean percentage IPA ( approximately 90 - 95 % ) , which exceeded that with AZD6140 50 mg bid or clopidogrel ( approximately 60 % ) . AZD6140 was generally well tolerated . All bleeding events , except one in a patient receiving 400 mg qd , were minor and of mild-to-moderate severity . CONCLUSION AZD6140 100 and 200 mg bid were well tolerated and were superior to AZD6140 50 mg bid and clopidogrel 75 mg qd with regard to antiplatelet efficacy
Most studies indicated that low on-treatment platelet reactivity ( LTPR ) , as measured by several platelet function tests , and the carriage of CYP2C19 * 17 allele were independent risk factors for bleeding .
A bleeding score also proved to be helpful in identifying patients at risk .
Several patient characteristics were also identified as independent predictors of bleeding , such as older age , female sex and renal failure .
Patients with coronary artery disease are usually treated with dual antiplatelet therapy ( DAPT ) after percutaneous coronary intervention .
Patients on DAPT are at risk of both ischaemic and bleeding events .
Although side-lined for a long time , real-life studies have shown that both the incidence and the associated morbidity and mortality of out-of-hospital bleeding are high .
This indicates that prevention of ( post-interventional ) bleeding is as important as prevention of ischaemia .
For this purpose it is crucial to reliably identify patients with a high bleeding risk .
In order to postulate an algorithm , which could help identifying these patients , we performed a systematic review to determine the value of previously proposed prognostic modalities for bleeding .