bluuebunny/crossref_metadata_2025_split huggingface dataset:
Platelet P2Y12 inhibitors
Authors: Pareek Manan , Bhatt Deepak L. 
Published: October 2023

Abstract
Adenosine diphosphate P2Y12 receptor antagonists inhibit platelet activation and subsequent aggregation. These agents may be used either alone or as part of dual antiplatelet therapy regimens with aspirin. P2Y12 inhibitors have proven useful in the treatment and prevention of several atherosclerotic cardiovascular conditions, including coronary, cerebrovascular, and peripheral artery disease. While clopidogrel served as the principal P2Y12 inhibitor for a decade, the more potent agents, prasugrel and ticagrelor, are now preferred in many settings, particularly in patients with an acute coronary syndrome. This chapter summarizes the main pharmacological properties of contemporary oral and intravenous P2Y12 inhibitors, and the major randomized controlled trials related to their clinical indications.
Dabigatran
Authors: Benz Alexander P. , Hohnloser Stefan H. 
Published: October 2023

Abstract
Dabigatran is a direct oral anticoagulant that acts through specific and reversible inhibition of thrombin. It has been developed as a fixed-dose, modern alternative to vitamin K antagonists such as warfarin. Dabigatran does not require frequent blood testing or dose adjustments. The main indication for dabigatran is the prevention of stroke and systemic embolism in patients with atrial fibrillation and risk factors for stroke. Furthermore, there is high-quality evidence supporting its use in patients with atrial fibrillation undergoing percutaneous coronary intervention or catheter ablation. Dabigatran has also received approval for the prevention of venous thromboembolism after major orthopaedic surgery and recurrent venous thromboembolism, and the treatment of venous thromboembolism. Dabigatran is contraindicated in patients with severe renal impairment (creatinine clearance &lt;30 mL/min), and in patients with moderate-to-severe mitral stenosis or with a mechanical heart valve prosthesis. Idarucizumab is a monoclonal antibody fragment that specifically reverses the anticoagulant activity of dabigatran.
Antithrombotic strategies in primary cardiovascular prevention
Authors: Michelotti Erica , Ridker Paul M. , De Caterina Raffaele 
Published: October 2023

Abstract
Antithrombotic strategies in primary cardiovascular prevention essentially revolve around the use of aspirin. This chapter provides an update and guidance for the use of aspirin in patients without previous clinical evidence of vascular disease. In contrast to secondary prevention, aspirin in primary prevention is widely debated in part because early trials predated the statin era. furthermore, because prevention of cardiovascular outcomes demonstrated in several trials was counterbalanced by increased risk for bleeding, a net clinical benefit has not clearly been shown in pooled estimates. Using data from the most recent trials, and performing a meta-regression of benefits and risks associated with aspirin use as related to the 10-year risk of major adverse cardiovascular events (MACEs), a tailored approach to aspirin prescription in primary prevention is proposed. In patients aged less than 70 years with optimal risk factor control, individual cardiovascular risk should be carefully evaluated, while also considering bleeding risk and patient preferences. Absolute MACE reduction appears superior to the hazard of haemorrhagic events in patients at intermediate–high cardiovascular risk without a prohibitive bleeding risk, and this category of individuals, as well as those with documented evidence of subclinical carotid, coronary, or peripheral atherosclerotic vascular disease, appear to be a proper target population. Treatment of other cardiovascular risk factors, such as high cholesterol, should, however, be prioritized prior to aspirin administration, and this should be accompanied, especially in the elderly, by the concurrent administration of gastroprotective agents.
Antithrombotic strategies in patients undergoing elective percutaneous coronary interventions and in chronic coronary syndromes without interventions
Authors: Greco Antonio , Capodanno Davide 
Published: October 2023

Abstract
Antithrombotic therapy plays a key role in the treatment and secondary prevention of coronary artery disease. After elective percutaneous coronary intervention or chronic coronary syndrome, dual antiplatelet therapy (DAPT) is usually indicated for 6 months. However, a risk stratification approach considering both the ischaemic and bleeding risks is of the utmost importance. Different antithrombotic regimens can be adopted, including strategies aimed at minimizing the risk of bleeding (i.e. shortening DAPT duration) or at enhancing antithrombotic protection (i.e. prolonging DAPT duration, switching to more potent P2Y12 inhibitors, or adding a low-dose anticoagulant to aspirin). The choice is even more challenging among patients who require, per se, long-term oral anticoagulation, in whom a triple therapy is theoretically indicated but unfeasible over the long term due to the excess bleeding risk. The aim of this chapter is to review the evidence supporting guideline recommendations in the field of antithrombotic therapy for patients with chronic coronary syndrome.
Antithrombotic therapy in ST-elevation acute myocardial infarction and non-ST elevation acute coronary syndromes
Authors: Parker William A.E. , De Caterina Raffaele , Moliterno David J. , Kristensen Steen Dalby , Storey Robert F. 
Published: October 2023

Abstract
Atherothrombosis is the central pathological process in acute coronary syndromes (ACS). Antithrombotic therapy is, therefore, a cornerstone of ACS treatment. As soon as ACS is suspected, aspirin should be commenced to reduce the risk of major adverse cardiovascular events. Addition of an oral P2Y12 inhibitor further reduces risk. Parenteral anticoagulation is indicated for any patient undergoing percutaneous coronary intervention (PCI) or thrombolysis, and for patients with non-ST elevation ACS where an early invasive treatment strategy is not pursued. In some cases of PCI for ST-elevation myocardial infarction, a platelet glycoprotein inhibitor may be utilized. Where timely primary PCI cannot be performed for ST-elevation myocardial infarction, thrombolysis with a tissue plasminogen activator may be recommended. Where there is an additional requirement for oral anticoagulation, in general patients treated by PCI should receive a short period of aspirin plus P2Y12 inhibitor plus oral anticoagulation before stopping aspirin, and then receive oral anticoagulation alone from 1 year.
Antithrombotic therapy for patients with prosthetic valves and during structural percutaneous interventions
Authors: Misumida Naoki , Alkhouli Mohamad , Moliterno David J. 
Published: October 2023

Abstract
Prosthetic heart valves are effective in alleviating symptoms of dysfunctional native valves. However, prosthetic valves are inherently inferior to native valves regarding haemodynamics, durability, and thrombogenicity. Antithrombotic therapy reduces the long-term risk of prosthetic valve thrombosis after mechanical valve replacement and can potentially mitigate the risk of acute or subacute leaflet thrombosis after bioprosthetic valve replacement. With the increasing complexity of patient undergoing valve replacement and the advent and growing use of direct oral anticoagulants, antithrombotic management among patients with valvular heart disease and prosthetic valves has become more intricate. This chapter reviews the current prophylactic and therapeutic strategies for the prevention and treatment of valve thrombosis and discusses future directions in this field.
Atrial fibrillation: current and forthcoming antithrombotic therapies
Authors: De Caterina Raffaele , Marcucci Rossella 
Published: October 2023

Abstract
Atrial fibrillation is the most common sustained arrhythmia, involving up to 1 out of 10 patients beyond 80 years of age. Its prevalence is increasing, only partly explained by the ageing of the population. Atrial fibrillation is a thrombogenic condition, with blood stasis in the left atrium/left atrial appendage and local structural abnormalities in the atrial walls favouring thrombus formation and distal embolization in the arterial circulation, causing 20–25% of ischaemic strokes. The risk of stroke in patients with atrial fibrillation is widely variable, from less than 1/100 patient-years (indistinguishable from the risk of the average population without the arrhythmia) to greater than 10/100 patient-years, depending on well-characterized risk factors, some of which are modifiable. Risk scores, such as the CHA2DS2-VASc, help in stratifying ischaemic risk, but are even more useful to identify patients who do not derive benefit—and possibly derive harm—from antithrombotic treatments. Anticoagulants are here the antithrombotic treatment of choice, and are clearly superior to aspirin for stroke prevention. In recent years, with few exceptions, the non-vitamin K antagonist oral anticoagulants have largely replaced vitamin K antagonists such as warfarin for stroke prevention, being at least equally effective and safer. An emerging role for stroke prevention is that of left atrial appendage occlusion, either percutaneous or surgical.
Antithrombotic therapies in inherited or acquired thrombophilia
Authors: Pengo Vittorio , Denas Gentian 
Published: October 2023

Abstract
The treatment of thrombophilias and their related clinical events is based on antithrombotic agents. Testing for inherited thrombophilia generally does not alter the clinical management of patients with venous or arterial thrombosis or pregnancy complications. An exception may be the presence of severe inherited thrombophilia that is usually rare and comprises deficiency of natural coagulation inhibitors (antithrombin, protein C, and protein S) or homozygosity and compound heterozygosity of factor V Leiden and prothrombin variant G20210A. In contrast, the presence of acquired thrombophilia guides antithrombotic treatment in affected patients. Appropriate treatment is important in patients with the antiphospholipid syndrome, heparin-induced thrombocytopenia, paroxysmal nocturnal haemoglobinuria, polycythaemia vera/essential thrombocythaemia, and sickle cell disease. Other common conditions of acquired thrombophilia, such as combined oral contraceptives and cancer-associated thrombosis, deserve special attention. Finally, the correct differential diagnosis of thrombotic microangiopathies is the basis of correct antithrombotic treatment.
Prevention and treatment of bleeding related to antithrombotic drugs
Authors: Mehran Roxana , Spirito Alessandro , Cao Davide , Dangas George 
Published: October 2023

Abstract
Antiplatelet and anticoagulant therapy reduce the occurrence of ischaemic events both in primary and secondary prevention in different cardiovascular conditions. However, these benefits come at the expense of higher bleeding complications, especially when different types of antithrombotic medications are combined. For decades, bleeding was thought to be an unavoidable side effect of antithrombotic therapy and of marginal relevance compared to ischaemic events. Yet, in recent years, major bleeding has been proven to impact mortality to a similar extent as ischaemic events. For these reasons, adoption of bleeding avoidance strategies is pivotal in the management of patients on antithrombotic therapy. These include an upfront bleeding risk assessment, accurate selection of candidates for invasive procedures, prevention of vascular access-related bleeding, modulation of antithrombotic therapy, and regular monitoring follow-up visits to reassess the bleeding risk and adjust the treatment. In case of bleeding, prompt treatment including reversal of antithrombotic treatment is required.
Management of patients treated with antithrombotic drugs undergoing surgery
Authors: Maeng Michael , Kristensen Steen Dalby , Siller-Matula Jolanta M. 
Published: October 2023

Abstract
Many patients with cardiovascular disease need surgery while on treatment with antiplatelet or anticoagulant drugs. Patient-related factors (severity of cardiovascular disease, comorbidities, age, and the type and combination of antithrombotic agents) and procedure-related factors (urgency, duration, and type of procedure) determine the risk of ischaemic and bleeding complications. Since major cardiovascular and bleeding events both occur frequently in the perioperative setting, the decision to interrupt or continue an antithrombotic agent must be carefully considered for each individual patient. Importantly, cardiovascular and bleeding events are interlinked since bleeding often leads to interruption of antithrombotic agents or transfusion of blood products, which may induce platelet hyperactivity. Also, surgery induces a prothrombotic state with enhanced risk of arterial and venous thrombosis. This chapter focuses on timing and duration of perioperative drug discontinuation, reversal for antiplatelet and antithrombotic agents, and when to resume antithrombotic therapy.
Antithrombotic therapy in patients with atrial fibrillation and recent coronary stenting, with or without an acute coronary syndrome
Authors: Fanaroff Alexander C. , Lopes Renato D. , Alexander John H. 
Published: October 2023

Abstract
Many patients with atrial fibrillation (AF) will ultimately undergo percutaneous coronary intervention (PCI) at some point in their lifetime. Though antithrombotic therapy is indicated for both conditions, anticoagulation is most effective for stroke prophylaxis in AF and dual antiplatelet therapy is most effective for prevention of stent thrombosis and myocardial infarction after PCI. However, the use of so-called triple therapy (oral anticoagulation + P2Y12 inhibitor + aspirin) in patients with AF who undergo PCI is associated with unacceptably high rates of major bleeding. Over the past decade, multiple clinical trials have tested alternate antithrombotic regimens in this patient population. Overall, these trials have indicated that the combination of a non-vitamin K antagonist oral anticoagulant plus clopidogrel, with only a short (7–30 days) course of aspirin, hits the sweet spot of limiting major bleeding while still providing acceptable protection from stroke, stent thrombosis, and myocardial infarction.
Antithrombotic agents and drug–drug interactions
Authors: Dunn Steven P. , Beavers Craig J. , Moliterno David J. 
Published: October 2023

Abstract
Drug–drug interactions affecting antiplatelet and anticoagulant medications are not uncommon, and among patients with cardiovascular disease, many receive polypharmacy thereby increasing the risk for important drug interactions. Such interactions may impact the efficacy or safety, or both, of antithrombotic medications. Since vitamin K antagonists have been widely used in clinical medicine for many years, drug interactions with agents such as warfarin are well known. Over recent years, newer and more potent antiplatelet and anticoagulant agents have been developed, and each of these has an identified potential to be impacted by other medications, primarily by affecting hepatic cytochromes involved with drug metabolism. While many interactions have been identified and alterations of plasma concentrations of drugs have been found, limited meaningful impacts on clinical outcomes have been discerned from large-scale trials. Drugs which importantly alter renal function may also pose a drug clearance issue for agents with a high proportion of the active compound being renally excreted. Lastly, the combination of anticoagulant agents poses the highest risk to patients as the antithrombotic impact is greatest as well as the risk for drug-related interactions among the antithrombotic agents and with other drugs. Recognition of these risks has led to increased scrutiny of anticoagulant safety by clinical care providers, pharmaceutical companies, health agencies, as well as accrediting bodies.
Personalized antithrombotic therapy: measuring individual variation and monitoring
Authors: van den Broek Wout W.A. , ten Berg Jur M. , Sibbing Dirk , Rizas Konstantinos D. 
Published: October 2023

Abstract
Antithrombotic drugs are frequently prescribed in patients with coronary artery disease, embolic stroke, or atrial fibrillation to prevent thrombosis. However, patients vary widely in their response to these drugs. This interindividual variability can be a result of genetic variation in enzymes that play a role in drug metabolism, though it can also be a consequence of other patient characteristics. A personalized antithrombotic treatment accounts for this interindividual variability with the aim of optimizing the balance between the risk of bleeding and thrombosis. Personalization of antithrombotic therapy might be done by testing for genetic polymorphisms or measuring the patient’s response on treatment, both of which have their advantages and disadvantages. This chapter describes the different ways that antithrombotic therapy can be personalized, provides the latest evidence for these strategies, and focuses on the treatment strategies with the most clinical impact.
Schizophrenia and the Error-Prediction Model of Thought Insertion
Authors: López-Silva Pablo , Cavieres Álvaro 
Published: October 2023

Abstract
Delusions of thought insertion (TI) are a severe symptom of psychosis with a higher prevalence in schizophrenia. People suffering from TI claim that external agents of different nature introduce thoughts into their minds in a generally altered experience of embodiment, external reality, and intersubjectivity. One of the most fundamental issues surrounding the clinical understanding of TI is the debate about how it is produced or, as it will be called in this chapter, the aetiological problem. Over the last years, the so-called error-prediction model of delusions has been gaining explanatory traction due to the way in which it brings together insights from neuroscience, computational psychiatry, and phenomenological psychopathology. This model claims that, in creating our conscious experience of reality, our brain uses prior learned predictions to infer the causes of incoming sensory data. Moreover, this process can be formalized as a type of Bayesian inference where probabilistic predictions are combined with observed sensory data to compute. After describing some of the most fundamental aspects of TI in the context of schizophrenia, this chapter examines a number of issues that applications of the prediction-error model to the aetiological problem face. Finally, in order to motivate further research in the field, we conclude with the description of a challenge that seems to remain open within the target debate.
What Can Magic and Science Tell Us About the Experience of Thought Insertion?
Authors: Pailhès Alice , Olson Jay , Kuhn Gustav 
Published: October 2023

Abstract
Mentalism is a magic genre that deals with mind reading, clairvoyance, prophecies, and thought insertion. Magicians often proclaim (performances, lectures), that they can insert specific thoughts into people’s minds, or unconsciously manipulate their behaviour. For example, magicians may give the illusion that they influence a person’s thoughts through telepathy or psychological priming (e.g., Derren Brown). In most instances, these demonstrations rely on a secret method that simply mimics thought insertion. These fake demonstrations can misinform the public and researchers about what may or may not be possible. This chapter will present in three sections how magicians provide the illusion that there are inserting thoughts into people’s minds and the recent scientific studies showing (1) magicians’ techniques that significantly influence simple thoughts and behaviours and (2) why magic provides a useful tool to mimic thought insertion and (3) how to mimic thought insertion with magic. We will try to distinguish fact from fiction and provide some insight into the type of thoughts magicians can or cannot reliably insert in people’s minds, and discuss the benefits of using magic to induce thought insertion-like symptoms in non-clinical populations.
Thought Insertion and Commitment
Authors: Fernández Jordi 
Published: October 2023

Abstract
In thought insertion, subjects claim to have thoughts which are not their own. This chapter offers an account of the thought insertion delusion by utilizing the notion of commitment, that is, the experience of a conscious state as being appropriate or fitting. The proposed explanation of thought insertion relies on two main tenets. One is that the experience of a thought as being one’s own is the experience of regarding that thought as being correct. The other one is that subjects with thought insertion do not experience being committed to the thoughts that they disown. The account is then extended to the case of patient RB, who disowns some of his conscious memories, and to the case of anarchic hand syndrome, in which patients disown some of their conscious actions.
Cultural influences on placebo and nocebo effects
Authors: Cundiff-O’Sullivan Rachel L. , Oula Desai , Shafir Roni , Colloca Luana 
Published: October 2023

Abstract
The meaning of illness and the context of treatment and expectations are known to influence patients’ responses to treatments, including placebo and nocebo effects. These meanings and expectations are rooted in a person’s cultural beliefs, norms, values, worldview, and experience. This chapter discusses just a few of the elements of culture that can affect placebo and nocebo responses. Cultural differences underlie preferences for the physical or aesthetic elements of treatments and how treatments are marketed and presented in the media. Spiritual and religious beliefs inform coping and other health behaviors. Rituals within both traditional and modern medical belief systems are important contextual factors in eliciting treatment responses. The preferred qualities of a healthcare provider and the interpersonal relationship between patient and provider, shaped by verbal and nonverbal cues, play key roles in maximizing healing. These cultural factors can influence individuals’ responsiveness to placebos and nocebos.
Predictability of placebo responses and their clinical implications
Authors: Branco Paulo , Vachon-Presseau Etienne , Hall Kathryn T. , Wager Tor D. , Vania Apkarian A. 
Published: October 2023

Abstract
The bulk of research on the mechanisms underlying placebo effects has been conducted for painful stimuli in laboratory settings. Such studies identify a long list of learning mechanisms that can explain observed effects, as well as provide evidence that placebo analgesia is associated with reproducible patterns of brain activity. These studies also show that placebo effects are unstable across contexts, and the magnitude of a participant’s response in one setting does not generalize following subtle manipulations of the procedure, suggesting that placebo effects are primarily driven by immediate, context-specific expectations and, thus, remain essentially unpredictable. Recent studies challenge this notion by finding that clinical placebo effects in chronic pain patients can be predicted by genetics, brain properties and language use. If replicated, latter results suggest that placebo effects can be understood and harnessed in clinical treatment of chronic pain conditions and beyond.