42 results on '"De Caterina, R"'
Search Results
2. Thromboembolism and antithrombotic therapy for heart failure in sinus rhythm
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Lip, Gregory Y. H., Ponikowski, Piotr, Andreotti, Felicita, Anker, Stefan D., Filippatos, Gerasimos, Homma, Shunichi, Morais, Joao, Pullicino, Patrick, Rasmussen, Lars H., Marin, Francisco, Lane, Deirdre A., McMurray, J., Hoes, A., Ten Berg, J., De Caterina, R., Kristensen, S. D., and Zeymer, U.
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- 2012
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3. Equal Antiplatelet Effects of Aspirin 50 or 324 mg/Day in Patients After Acute Myocardial Infarction
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De Caterina, R, Giannessi, D, Boem, A, Bernini, W, Battaglia, D, Michelassi, C, Dell’Amico, F, L’Abbate, A, Patrignani, P, and Patrono, C
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- 1985
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4. MECHANISMS FOR THE IN VIVO ANTIPLATELET EFFECTS OF ORGANIC NITRATES
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De Caterina, R, additional, Giannessi, D, additional, Bernini, W, additional, and Mazzone, A, additional
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- 1987
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5. RELATIVE SENSITIVITY OF CARDIAC PROSTACYCLIN AND THROMBOXANE TO INHIBITION BY NON-STEROIDAL ANTIINFLAMMATORY DRUGS IN THE RAT HEART
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Giannessi, D, De Caterina, R, Lazzerini, G, Sicari, R, and Gazzetti, P
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- 1987
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6. Inconstancy Of PGI2 Administration In Preventing Attacks Of Prinzmetal Angina
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Chierchia, S, De Caterina, R, Crea, F, Bernini, W, Distante, A, Maseri, A, and L’Abbate, A
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- 1981
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7. Heparin in COVID-19 Patients Is Associated with Reduced In-Hospital Mortality: The Multicenter Italian CORIST Study.
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Di Castelnuovo A, Costanzo S, Antinori A, Berselli N, Blandi L, Bonaccio M, Cauda R, Guaraldi G, Menicanti L, Mennuni M, Parruti G, Patti G, Santilli F, Signorelli C, Vergori A, Abete P, Ageno W, Agodi A, Agostoni P, Aiello L, Al Moghazi S, Arboretti R, Astuto M, Aucella F, Barbieri G, Bartoloni A, Bonfanti P, Cacciatore F, Caiano L, Carrozzi L, Cascio A, Ciccullo A, Cingolani A, Cipollone F, Colomba C, Colombo C, Crosta F, Danzi GB, D'Ardes D, de Gaetano Donati K, Di Gennaro F, Di Tano G, D'Offizi G, Fantoni M, Fusco FM, Gentile I, Gianfagna F, Grandone E, Graziani E, Grisafi L, Guarnieri G, Larizza G, Leone A, Maccagni G, Madaro F, Maitan S, Mancarella S, Mapelli M, Maragna R, Marcucci R, Maresca G, Marongiu S, Marotta C, Marra L, Mastroianni F, Mazzitelli M, Mengozzi A, Menichetti F, Meschiari M, Milic J, Minutolo F, Molena B, Montineri A, Mussini C, Musso M, Niola D, Odone A, Olivieri M, Palimodde A, Parisi R, Pasi E, Pesavento R, Petri F, Pinchera B, Poletti V, Ravaglia C, Rognoni A, Rossato M, Rossi M, Sangiovanni V, Sanrocco C, Scorzolini L, Sgariglia R, Simeone PG, Taddei E, Torti C, Vettor R, Vianello A, Vinceti M, Virano A, Vocciante L, De Caterina R, and Iacoviello L
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- Aged, Blood Coagulation drug effects, COVID-19 blood, Female, Hospital Mortality, Humans, Italy epidemiology, Male, Middle Aged, Retrospective Studies, Survival Analysis, Thrombophilia blood, COVID-19 Drug Treatment, Anticoagulants therapeutic use, COVID-19 complications, Heparin therapeutic use, Heparin, Low-Molecular-Weight therapeutic use, Thrombophilia etiology, Thrombophilia prevention & control
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Introduction: A hypercoagulable condition was described in patients with coronavirus disease 2019 (COVID-19) and proposed as a possible pathogenic mechanism contributing to disease progression and lethality., Aim: We evaluated if in-hospital administration of heparin improved survival in a large cohort of Italian COVID-19 patients., Methods: In a retrospective observational study, 2,574 unselected patients hospitalized in 30 clinical centers in Italy from February 19, 2020 to June 5, 2020 with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection were analyzed. The primary endpoint in a time-to event analysis was in-hospital death, comparing patients who received heparin (low-molecular-weight heparin [LMWH] or unfractionated heparin [UFH]) with patients who did not. We used multivariable Cox proportional-hazards regression models with inverse probability for treatment weighting by propensity scores., Results: Out of 2,574 COVID-19 patients, 70.1% received heparin. LMWH was largely the most used formulation (99.5%). Death rates for patients receiving heparin or not were 7.4 and 14.0 per 1,000 person-days, respectively. After adjustment for propensity scores, we found a 40% lower risk of death in patients receiving heparin (hazard ratio = 0.60; 95% confidence interval: 0.49-0.74; E-value = 2.04). This association was particularly evident in patients with a higher severity of disease or strong coagulation activation., Conclusion: In-hospital heparin treatment was associated with a lower mortality, particularly in severely ill COVID-19 patients and in those with strong coagulation activation. The results from randomized clinical trials are eagerly awaited to provide clear-cut recommendations., Competing Interests: None declared., (Thieme. All rights reserved.)
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- 2021
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8. Aspirin Therapy for Primary Prevention: The Case for Continuing Prescribing to Patients at High Cardiovascular Risk-A Review.
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De Caterina R, Aimo A, and Ridker PM
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- Aged, Aspirin adverse effects, Cardiovascular System drug effects, Diabetes Complications drug therapy, Hemorrhage prevention & control, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Odds Ratio, Practice Patterns, Physicians', Primary Prevention, Randomized Controlled Trials as Topic, Risk Assessment methods, Risk Factors, Secondary Prevention, Aspirin therapeutic use, Cardiology methods, Cardiology standards, Cardiovascular Diseases prevention & control
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Current evidence supports the use of low-dose aspirin for secondary cardiovascular prevention. By contrast, the benefit-to-risk ratio of aspirin use in primary prevention is debated: three contemporary randomized control trials have been conflicting, and meta-analyses have concluded for an unclear clinical benefit, based on the consideration that the reduction in thromboembolic events is counterbalanced by increased bleeding. The primary prevention setting is, however, a heterogeneous mix of subjects at highly variable cardiovascular risk. One possible explanation for the uncertainty of data interpretation is the progressive reduction in risk of major adverse cardiovascular events (MACEs) in primary prevention that has accompanied global education programs, leading patients to smoke less, exercise more, and increasingly take lipid-lowering therapies. Based on a meta-regression of the benefits and harm of aspirin therapy in primary prevention as a function of the 10-year risk of MACE, we favor a nuanced approach still, however, based on the evaluation of cardiovascular risk, acknowledging differences between patients and emphasizing an individualized assessment of both benefits and harm. After optimal control of cardiovascular risk factors, and when patients are less than 70 years of age, clinicians should assess the risk of MACE and base decision on such stratification, considering the risk of bleeding and patient preferences. Clinicians would then advise the use of aspirin in primary prevention patients at the highest risk of MACE who do not have a prohibitive risk of bleeding, and in the majority of cases after initiation of properly titrated statin therapy., Competing Interests: R.D.C. declares having received fees and honoraria from Bayer related to the topic. A.A. and P.M.R. have no conflict of interest to disclose., (Georg Thieme Verlag KG Stuttgart · New York.)
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- 2020
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9. Platelet Indices and Risk of Death and Cardiovascular Events: Results from a Large Population-Based Cohort Study.
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Patti G, Di Martino G, Ricci F, Renda G, Gallina S, Hamrefors V, Melander O, Sutton R, Engström G, De Caterina R, and Fedorowski A
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- Aged, Cardiovascular Diseases diagnosis, Cause of Death, Female, Humans, Incidence, Male, Middle Aged, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Assessment, Risk Factors, Sweden epidemiology, Time Factors, Blood Platelets, Cardiovascular Diseases blood, Cardiovascular Diseases mortality, Platelet Count
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Studies evaluating the relationship between platelet indices and cardiovascular (CV) outcomes yielded conflicting results. We assessed the incidence of adverse events according to baseline quintiles of platelet indices in the prospective cohort of the Malmö Diet and Cancer Study. A total of 30,314 individuals (age 57 ± 8 years) were followed for a median of 16 years (468,490 person-years). Outcome measures included all-cause death, CV death, myocardial infarction (MI), and ischemic stroke. The fifth quintile of platelet count (> 274.6 × 10
9 /L) was associated with higher incidence of all-cause death (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09-1.32, p < 0.001), CV death (HR 1.19, 95% CI 1.00-1.42; p = 0.044), MI (HR 1.32, 95% CI 1.12-1.54; p = 0.001), and ischemic stroke (HR 1.27, 95% CI 1.08-1.50, p = 0.004) compared with the first quintile (≤ 185 × 109 /L), and also associated with a lower survival, regardless of previous history of MI ( p for interaction = 0.58) or stroke ( p for interaction = 0.42). In the highest quintile, history of stroke had a higher risk of CV death (HR 3.18, 95% CI 1.54-6.54) compared with no previous stroke (HR 1.12, 95% CI 0.96-1.31). The risk of MI and stroke was greatest in the fifth quintile, regardless of previous MI or previous stroke, respectively. The risk of all adverse events was similar across different quintiles of mean platelet volume. In conclusion, elevated platelet count is associated with higher mortality and risk of CV events, regardless of previous MI and stroke. Platelet count may thus be a useful marker for further stratification of CV risk, and especially of death., Competing Interests: G.P.: Speaker/consultant/advisory board for Amgen, Sanofi, Bayer, Boehringer-Ingelheim, BMS-Pfizer, Daiichi Sankyo, Astra Zeneca, Sigma-Tau, Malesci, PIAM, and MSD, outside the submitted work. G.R.: Speaker/consultant/advisory board for Boehringer-Ingelheim, Daiichi-Sankyo, and Bayer. V.H.: Educational funding from Boston Scientific and shareholder in AstraZeneca and Swedish Orphan Biovitrum, outside the submitted work. R.S.: Consultant to Medtronic Inc., member of speakers' bureau of Abbott Labs and stock holder in Edwards Lifescience, Boston Scientific Inc., and AstraZeneca PLC. R.D.C.: Fees, honoraria, and research funding from Sanofi-Aventis, Boehringer-Ingelheim, Bayer, BMS/Pfizer, Daiichi-Sankyo, Novartis, MSD, and Portola, outside the submitted work. G.R.: Personal fees from Bayer, Boehringer-Ingelheim, Daiichi Sankyo, outside the submitted work. A.F.: Speaker/consultant/advisory board for Medtronic and honoraria and royalties from Cardiome and Thermofisher, outside the submitted work. R.S.: Other from Boston Scientific, Astra Zeneca PLC, Edwards Lifescience, personal fees from Medtronic, Abbott laboratories, outside the submitted work. All other authors report no conflict of interest., (Georg Thieme Verlag KG Stuttgart · New York.)- Published
- 2019
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10. The Non-Vitamin K Antagonist Oral Anticoagulants in Heart Disease: Section V-Special Situations.
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De Caterina R, Ageno W, Agnelli G, Chan NC, Diener HC, Hylek E, Raskob GE, Siegal DM, Verheugt FWA, Lip GYH, and Weitz JI
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- Administration, Oral, Antibodies, Monoclonal, Humanized therapeutic use, Arginine analogs & derivatives, Arginine therapeutic use, Atrial Fibrillation prevention & control, Benzamides therapeutic use, Biomarkers metabolism, Blood Coagulation, Clinical Trials as Topic, Dabigatran therapeutic use, Drug Administration Schedule, Factor Xa therapeutic use, Heart Diseases drug therapy, Humans, Piperazines therapeutic use, Pyrazoles therapeutic use, Pyridines therapeutic use, Pyridones therapeutic use, Recombinant Proteins therapeutic use, Risk, Rivaroxaban therapeutic use, Stroke prevention & control, Thiazoles therapeutic use, Venous Thromboembolism drug therapy, Warfarin therapeutic use, Anticoagulants therapeutic use, Heart Diseases complications, Thrombin antagonists & inhibitors, Vitamin K antagonists & inhibitors
- Abstract
Non-vitamin K antagonist oral anticoagulants (NOACs) include dabigatran, which inhibits thrombin, and apixaban, betrixaban, edoxaban and rivaroxaban, which inhibit factor Xa. In large clinical trials comparing the NOACs with the vitamin K antagonist (VKA) warfarin, dabigatran, apixaban, rivaroxaban and edoxaban were at least as effective for stroke prevention in atrial fibrillation and for treatment of venous thromboembolism, but were associated with less intracranial bleeding. In addition, the NOACs are more convenient to administer than VKAs because they can be given in fixed doses without routine coagulation monitoring. Consequently, the NOACs are now replacing VKAs for these indications, and their use is increasing. Although, as a class, the NOACs have a favourable benefit-risk profile compared with VKAs, choosing among them is complicated because they have not been compared in head-to-head trials. Therefore, selection depends on the results of the individual trials, renal function, the potential for drug-drug interactions and preference for once- or twice-daily dosing. In addition, several 'special situations' were not adequately studied in the dedicated clinical trials. For these situations, knowledge of the unique pharmacological features of the various NOACs and judicious cross-trial comparison can help inform prescription choices. The purpose of this position article is therefore to help clinicians choose the right anticoagulant for the right patient at the right dose by reviewing a variety of special situations not widely studied in clinical trials., Competing Interests: The authors declare the following potential conflicts of interest: Raffaele De Caterina declares fees, honoraria and research funding from Sanofi-Aventis, Boehringer Ingelheim, Bayer, BMS/Pfizer, Daiichi-Sankyo, Novartis, MSD and Portola. Walter Ageno declares honoraria from Boehringer Ingelheim, Bayer, Bristol-Myers Squibb/Pfizer, Daiichi Sankyo, Aspen, Stago, CSL Behring and Portola, and research funding from Bayer. Giancarlo Agnelli declares honoraria from Bayer, BMS/Pfizer, Daiichi Sankyo and Sanofi. Noel C. Chan declares honoraria from Bayer and Boehringer Ingelheim. Hans-Christoph Diener declares honoraria for participation in clinical trials, contribution to advisory boards or oral presentations from: Abbott, Achelios, Allergan, AstraZeneca, Bayer Vital, BMS, Boehringer Ingelheim, CoAxia, Corimmun, Covidien, Daiichi-Sankyo, D-Pharm, Fresenius, GlaxoSmithKline, Janssen-Cilag, Johnson & Johnson, Knoll, Lilly, MSD, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, Portola, Sanofi-Aventis, Schering-Plough, Servier, Solvay, St. Jude, Syngis, Talecris, Thrombogenics, WebMD Global, Wyeth and Yamanouchi. Financial support for research projects was provided by AstraZeneca, GSK, Boehringer Ingelheim, Lundbeck, Novartis, Janssen-Cilag, Sanofi-Aventis, Syngis and Talecris. The Department of Neurology at the University Duisburg-Essen received research grants from the German Research Council (DFG), German Ministry of Education and Research (BMBF), European Union, NIH, Bertelsmann Foundation and Heinz-Nixdorf Foundation. Hans-Christoph Diener has no ownership interest and does not own stocks of any pharmaceutical company. Within the past year he served as editor of Aktuelle Neurologie, Arzneimitteltherapie, Kopfschmerznews, Stroke News, as co-editor of Cephalalgia, and is on the editorial board of Lancet Neurology, Stroke, European Neurology and Cerebrovascular Disorders. He chairs the Treatment Guidelines Committee of the German Society of Neurology and contributed to the EHRA and ESC guidelines for the treatment of AF. Elaine Hylek declares honoraria from Bayer, Boehringer Ingelheim, Bristol Myers Squibb/Pfizer, DOASENSE, Janssen, Medtronic and Portola, and research funding from Janssen. Gary E. Raskob declares consultant fees and/or honoraria from Bayer, BMS, Boehringer-Ingelheim, Daiichi-Sankyo, Eli-Lilly, Janssen, Johnson & Johnson, Novartis, Pfizer and Portola. Deborah M. Siegal declares honoraria for presentations from Bayer, Portola, BMS-Pfizer and Servier. Freek W.A. Verheugt declares having received educational and research grants from Bayer Healthcare, as well as honoraria for consultancies/presentations from Bayer Healthcare, BMS/Pfizer, Daiichi-Sankyo and Boehringer Ingelheim. Gregory Y. H. Lip is a consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi-Sankyo; and speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim and Daiichi-Sankyo. No fees are directly received personally. Jeffrey I. Weitz declares consultancy fees and honoraria from Boehringer Ingelheim, Bayer, Janssen, BMS/Pfizer, Daiichi-Sankyo, Novartis, Portola, IONIS and Servier., (Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2019
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11. Antithrombotic Therapy in Atrial Fibrillation Associated with Valvular Heart Disease: Executive Summary of a Joint Consensus Document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, Endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).
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Lip GYH, Collet JP, de Caterina R, Fauchier L, Lane DA, Larsen TB, Marin F, Morais J, Narasimhan C, Olshansky B, Pierard L, Potpara T, Sarrafzadegan N, Sliwa K, Varela G, Vilahur G, Weiss T, Boriani G, and Rocca B
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- Administration, Oral, Africa, Southern, Asia, Atrial Fibrillation epidemiology, Europe, Evidence-Based Medicine, Expert Testimony, Heart Valve Diseases epidemiology, Humans, Latin America, Practice Guidelines as Topic, Risk, Vitamin K antagonists & inhibitors, Atrial Fibrillation drug therapy, Fibrinolytic Agents therapeutic use, Heart Valve Diseases drug therapy, Stroke prevention & control
- Abstract
Management strategies for patients with atrial fibrillation (AF) in association with valvular heart disease (VHD) have been less informed by randomized trials, which have largely focused on ‘non-valvular AF’ patients. Thromboembolic risk also varies according to valve lesion and may also be associated with CHA2DS2-VASc score risk factor components, rather than only the valve disease being causal. Given the need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD, a task force was convened by the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group (WG) on Thrombosis, with representation from the ESC WG on Valvular Heart Disease, Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE) with the remit to comprehensively review the published evidence, and to produce a consensus document on the management of patients with AF and associated VHD, with up-to-date consensus statements for clinical practice for different forms of VHD, based on the principles of evidence-based medicine. This is an executive summary of a consensus document which proposes that the term ‘valvular AF’ is outdated and given that any definition ultimately relates to the evaluated practical use of oral anticoagulation (OAC) type, we propose a functional EHRA (Evaluated Heartvalves, Rheumatic or Artificial) categorization in relation to the type of OAC use in patients with AF, as follows: (1) EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 1 VHD, which refers to AF patients with ‘VHD needing therapy with a vitamin K antagonist (VKA)’ and (2) EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 2 VHD, which refers to AF patients with ‘VHD needing therapy with a VKA or a non-VKA oral anticoagulant also taking into consideration CHA2DS2-VASc score risk factor components., Competing Interests: Disclosure The authors report no conflicts of interest in this work.
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- 2017
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12. Stroke prevention in atrial fibrillation: Past, present and future. Comparing the guidelines and practical decision-making.
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Lip G, Freedman B, De Caterina R, and Potpara TS
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- Algorithms, Anticoagulants adverse effects, Anticoagulants therapeutic use, Decision Making, Hemorrhage chemically induced, Humans, Practice Guidelines as Topic, Randomized Controlled Trials as Topic, Risk Assessment, Atrial Fibrillation drug therapy, Stroke prevention & control
- Abstract
Concepts and our approaches to stroke prevention in atrial fibrillation (AF) have changed markedly over the last decade. There has been an evolution over the approach to stroke and bleeding risk assessment, as well as new treatment options. An increasing awareness of AF has led to calls to improve the detection of and population screening for AF. Stroke and bleeding risk assessment continues to evolve, and the ongoing debate on balance between simplicity and practicality, against precision medicine will continue. In this review article, we provide an overview of past, present and the (likely) future concepts and approaches to stroke prevention in AF. We propose three simple steps (the Birmingham '3-step') that offers a practical management pathway to help streamline and simplify decision-making for stroke prevention in patients with AF.
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- 2017
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13. Inflammation and thrombosis - testing the hypothesis with anti-inflammatory drug trials.
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De Caterina R, D'Ugo E, and Libby P
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- Humans, Anti-Inflammatory Agents therapeutic use, Atherosclerosis prevention & control, Inflammation drug therapy, Thrombosis prevention & control
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The hypothesis of atherosclerosis as an inflammatory process has been a leitmotiv in cardiology for the past 20 years, and has now led to the launch of clinical trials aimed at testing whether drugs that primarily target inflammation can reduce cardiovascular events. Inflammation indeed drives all phases of atherosclerosis, from inception, through progression, and ultimately acute thrombotic complications (plaque rupture and probably plaque erosion). Since plaque rupture and erosion cause most acute coronary syndromes, appropriately tuned anti-inflammatory treatments should limit myocardial infarction and cardiovascular death. Beyond interrupting inflammation-related plaque disruption, such treatments might, however, also ameliorate the propensity to thrombosis once the trigger (plaque rupture or erosion) has occurred. Several lines of evidence support this view: experimental data document the role of inflammation in platelet activation, tissue factor-mediated coagulation, hyperfibrinogenaemia, impaired activity of natural anticoagulants (including those expressed by endothelial cells), and reduced fibrinolytic activity. Supporting evidence also derives from the involvement of inflammation in venous thrombosis, a process that commonly occurs in the absence of traditional risk factors for atherosclerosis but is associated with several inflammatory diseases including obesity. Ongoing trials, in addition to evaluating effects on primary outcomes, will afford the opportunity to probe the possibility that anti-inflammatory interventions that yield salutary changes in biomarkers of the thrombotic/fibrinolytic balance also translate into reduction of clinical events.
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- 2016
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14. Oral anticoagulants in coronary heart disease (Section IV). Position paper of the ESC Working Group on Thrombosis - Task Force on Anticoagulants in Heart Disease.
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De Caterina R, Husted S, Wallentin L, Andreotti F, Arnesen H, Bachmann F, Baigent C, Collet JP, Halvorsen S, Huber K, Jespersen J, Kristensen SD, Lip GY, Morais J, Rasmussen LH, Ricci F, Sibbing D, Siegbahn A, Storey RF, Ten Berg J, Verheugt FW, and Weitz JI
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- Administration, Oral, Animals, Clinical Trials as Topic, Dabigatran therapeutic use, Drug Interactions, Humans, Platelet Aggregation Inhibitors therapeutic use, Pyrazoles therapeutic use, Pyridines therapeutic use, Pyridones therapeutic use, Rivaroxaban therapeutic use, Thiazoles therapeutic use, Anticoagulants therapeutic use, Coronary Artery Disease drug therapy
- Abstract
Until recently, vitamin K antagonists (VKAs) were the only available oral anticoagulants evaluated for long-term treatment of patients with coronary heart disease (CHD), particularly after an acute coronary syndrome (ACS). Despite efficacy in this setting, VKAs are rarely used because they are cumbersome to administer. Instead, the more readily manageable antiplatelet agents are the mainstay of prevention in ACS patients. This situation has the potential to change with the introduction of non-VKA oral anticoagulants (NOACs), which are easier to administer than VKAs because they can be given in fixed doses without routine coagulation monitoring. The NOACs include dabigatran, which inhibits thrombin, and apixaban, rivaroxaban and edoxaban, which inhibit factor Xa. Apixaban and rivaroxaban were evaluated in phase III trials for prevention of recurrent ischaemia in ACS patients, most of whom were also receiving dual antiplatelet therapy with aspirin and clopidogrel. Although at the doses tested rivaroxaban was effective and apixaban was not, both agents increased major bleeding. The role for the NOACs in ACS management, although promising, is therefore complicated, because it is uncertain how they compare with newer antiplatelet agents, such as prasugrel, ticagrelor or vorapaxar, and because their safety in combination with these other drugs is unknown. Ongoing studies are also now evaluating the use of NOACs in non-valvular atrial fibrillation patients, where their role is established, with coexistent ACS or coronary stenting. Focusing on CHD, we review the results of clinical trials with the NOACs and provide a perspective on their future incorporation into clinical practice.
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- 2016
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15. Cancer after intense and prolonged antiplatelet therapies--fact or fiction?
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De Caterina R
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- Humans, Neoplasms
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- 2015
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16. Bivalirudin for acute coronary syndromes: premises, promises and doubts.
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Capodanno D and De Caterina R
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- Acute Coronary Syndrome blood, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome economics, Acute Coronary Syndrome mortality, Anticoagulants adverse effects, Anticoagulants economics, Anticoagulants pharmacokinetics, Cost-Benefit Analysis, Drug Costs, Hemorrhage chemically induced, Hirudins adverse effects, Hirudins economics, Hirudins pharmacokinetics, Humans, Myocardial Infarction blood, Myocardial Infarction diagnosis, Myocardial Infarction economics, Myocardial Infarction mortality, Peptide Fragments adverse effects, Peptide Fragments economics, Peptide Fragments pharmacokinetics, Recombinant Proteins adverse effects, Recombinant Proteins economics, Recombinant Proteins pharmacokinetics, Recombinant Proteins therapeutic use, Risk Assessment, Risk Factors, Treatment Outcome, Acute Coronary Syndrome therapy, Anticoagulants therapeutic use, Myocardial Infarction therapy, Peptide Fragments therapeutic use, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention economics, Percutaneous Coronary Intervention mortality
- Abstract
Bivalirudin is a valuable anticoagulant option in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention. Advantages over heparin as a parenteral anticoagulant include more predictable pharmacokinetics and pharmacodynamics, shorter half-life, no need for cofactors, some degree of antiplatelet effect, and the ability to inhibit clot-bound thrombin. Clinical evidence supporting the use of bivalirudin over heparin in current ACS guidelines, however, derives mostly from early randomised trials that may no longer reflect current management patterns, now including the use of oral antiplatelet agents more potent than clopidogrel (i.e. prasugrel or ticagrelor) and a broader implementation of strategies to reduce bleeding (i.e. radial access for percutaneous coronary intervention, and use of glycoprotein IIb/IIIa inhibitors only in bailout situations). Defining the fine balance between bivalirudin efficacy and safety over heparins in the context of other antithrombotic treatments remains a challenge in clinical practice, particularly in a fast-evolving scenario, such as ACS, where numerous new trials have been presented in very recent times. Here we provide an up-to-date overview of the evidence on the use of bivalirudin in ACS, with focus on new data, open issues, and future directions.
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- 2015
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17. Differences among western European countries in anticoagulation management of atrial fibrillation. Data from the PREFER IN AF registry.
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Le Heuzey JY, Ammentorp B, Darius H, De Caterina R, Schilling RJ, Schmitt J, Zamorano JL, and Kirchhof P
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- Acenocoumarol therapeutic use, Administration, Oral, Aged, Aged, 80 and over, Atrial Fibrillation drug therapy, Europe, Female, Humans, Male, Middle Aged, Phenindione analogs & derivatives, Phenindione therapeutic use, Phenprocoumon therapeutic use, Practice Guidelines as Topic, Vitamin K antagonists & inhibitors, Warfarin therapeutic use, Withholding Treatment statistics & numerical data, Anticoagulants therapeutic use, Atrial Fibrillation epidemiology, Registries statistics & numerical data
- Abstract
Due to improved implementation of guidelines, new scoring approaches to improve risk categorisation, and introduction of novel oral anticoagulants, medical management of patients with atrial fibrillation (AF) is continuously improving. The PREFER in AF registry enrolled 7,243 consecutive patients with ECG-confirmed AF in seven European countries in 2012-2013 (mean age: 71.5 ± 10.7 years; 60.1% males; mean CHA2DS2-VASc score: 3.4). While patient characteristics were generally homogeneous across countries, anticoagulation management showed important differences: the proportion of patients taking vitamin K antagonists (VKAs) varied between 86.0% (in France) and 71.4% (in Italy). Warfarin was used predominantly in the UK and Italy (74.9% and 62.0%, respectively), phenprocoumon in Germany (74.1%), acenocoumarol in Spain (67.3%), and fluindione in France (61.8 %). The major sites for international normalised ratio (INR) measurements were biology laboratories in France, anticoagulation clinics in Italy, Spain, and the UK, and physicians' offices or self-measurement in Germany. Temporary VKA discontinuation and bridging with other anticoagulants was frequent (at least once in the previous 12 months for 22.9% of the patients, on average; ranging from 29.7% in Germany to 14.9% in the UK). Time in therapeutic range (TTR), defined as at least two of the last three available INR values between 2.0-3.0 prior to enrolment, ranged from 70.3% in Spain to 81.4% in Germany. TTR was constantly overestimated by physicians. While the type and half-lives of VKA as well as the mode of INR surveillance differed, overall quality of anticoagulation management by TTR was relatively homogenous in AF patients across countries.
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- 2014
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18. Non-vitamin K antagonist oral anticoagulants (NOACs): No longer new or novel.
- Author
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Husted S, de Caterina R, Andreotti F, Arnesen H, Bachmann F, Huber K, Jespersen J, Kristensen SD, Lip GY, Morais J, Rasmussen LH, Siegbahn A, Storey RF, and Weitz JI
- Subjects
- Administration, Oral, Clinical Trials as Topic, Contraindications, Humans, Liver Diseases complications, Practice Guidelines as Topic, Renal Insufficiency complications, Thromboembolism complications, Vitamin K antagonists & inhibitors, Anticoagulants therapeutic use, Blood Coagulation Factors metabolism, Liver Diseases drug therapy, Renal Insufficiency drug therapy, Thromboembolism drug therapy
- Published
- 2014
- Full Text
- View/download PDF
19. Vitamin K antagonists in heart disease: current status and perspectives (Section III). Position paper of the ESC Working Group on Thrombosis--Task Force on Anticoagulants in Heart Disease.
- Author
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De Caterina R, Husted S, Wallentin L, Andreotti F, Arnesen H, Bachmann F, Baigent C, Huber K, Jespersen J, Kristensen SD, Lip GY, Morais J, Rasmussen LH, Siegbahn A, Verheugt FW, and Weitz JI
- Subjects
- Advisory Committees, Anticoagulants pharmacology, Blood Coagulation drug effects, Europe, Heart Diseases blood, Humans, Societies, Medical, Thrombosis blood, Anticoagulants therapeutic use, Cardiology, Heart Diseases drug therapy, Thrombosis drug therapy, Vitamin K antagonists & inhibitors
- Abstract
Oral anticoagulants are a mainstay of cardiovascular therapy, and for over 60 years vitamin K antagonists (VKAs) were the only available agents for long-term use. VKAs interfere with the cyclic inter-conversion of vitamin K and its 2,3 epoxide, thus inhibiting γ-carboxylation of glutamate residues at the amino-termini of vitamin K-dependent proteins, including the coagulation factors (F) II (prothrombin), VII, IX and X, as well as of the anticoagulant proteins C, S and Z. The overall effect of such interference is a dose-dependent anticoagulant effect, which has been therapeutically exploited in heart disease since the early 1950s. In this position paper, we review the mechanisms of action, pharmacological properties and side effects of VKAs, which are used in the management of cardiovascular diseases, including coronary heart disease (where their use is limited), stroke prevention in atrial fibrillation, heart valves and/or chronic heart failure. Using an evidence-based approach, we describe the results of completed clinical trials, highlight areas of uncertainty, and recommend therapeutic options for specific disorders. Although VKAs are being increasingly replaced in most patients with non-valvular atrial fibrillation by the new oral anticoagulants, which target either thrombin or FXa, the VKAs remain the agents of choice for patients with atrial fibrillation in the setting of rheumatic valvular disease and for those with mechanical heart valves.
- Published
- 2013
- Full Text
- View/download PDF
20. Parenteral anticoagulants in heart disease: current status and perspectives (Section II). Position paper of the ESC Working Group on Thrombosis-Task Force on Anticoagulants in Heart Disease.
- Author
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De Caterina R, Husted S, Wallentin L, Andreotti F, Arnesen H, Bachmann F, Baigent C, Huber K, Jespersen J, Kristensen SD, Lip GY, Morais J, Rasmussen LH, Siegbahn A, Verheugt FW, and Weitz JI
- Subjects
- Acute Coronary Syndrome blood, Acute Coronary Syndrome drug therapy, Anticoagulants adverse effects, Atrial Fibrillation blood, Atrial Fibrillation drug therapy, Drug Administration Routes, Heart Diseases blood, Heart Diseases diagnosis, Heart Valve Prosthesis Implantation standards, Humans, Percutaneous Coronary Intervention standards, Treatment Outcome, Anticoagulants administration & dosage, Blood Coagulation drug effects, Cardiology standards, Heart Diseases drug therapy
- Abstract
Anticoagulants are a mainstay of cardiovascular therapy, and parenteral anticoagulants have widespread use in cardiology, especially in acute situations. Parenteral anticoagulants include unfractionated heparin, low-molecular-weight heparins, the synthetic pentasaccharides fondaparinux, idraparinux and idrabiotaparinux, and parenteral direct thrombin inhibitors. The several shortcomings of unfractionated heparin and of low-molecular-weight heparins have prompted the development of the other newer agents. Here we review the mechanisms of action, pharmacological properties and side effects of parenteral anticoagulants used in the management of coronary heart disease treated with or without percutaneous coronary interventions, cardioversion for atrial fibrillation, and prosthetic heart valves and valve repair. Using an evidence-based approach, we describe the results of completed clinical trials, highlight ongoing research with currently available agents, and recommend therapeutic options for specific heart diseases.
- Published
- 2013
- Full Text
- View/download PDF
21. General mechanisms of coagulation and targets of anticoagulants (Section I). Position Paper of the ESC Working Group on Thrombosis--Task Force on Anticoagulants in Heart Disease.
- Author
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De Caterina R, Husted S, Wallentin L, Andreotti F, Arnesen H, Bachmann F, Baigent C, Huber K, Jespersen J, Kristensen SD, Lip GY, Morais J, Rasmussen LH, Siegbahn A, Verheugt FW, and Weitz JI
- Subjects
- Anticoagulants adverse effects, Blood Coagulation Tests, Guideline Adherence standards, Heart Diseases blood, Heart Diseases epidemiology, Humans, Practice Patterns, Physicians' standards, Treatment Outcome, Anticoagulants therapeutic use, Blood Coagulation drug effects, Heart Diseases drug therapy
- Abstract
Contrary to previous models based on plasma, coagulation processes are currently believed to be mostly cell surface-based, including three overlapping phases: initiation, when tissue factor-expressing cells and microparticles are exposed to plasma; amplification, whereby small amounts of thrombin induce platelet activation and aggregation, and promote activation of factors (F)V, FVIII and FXI on platelet surfaces; and propagation, in which the Xase (tenase) and prothrombinase complexes are formed, producing a burst of thrombin and the cleavage of fibrinogen to fibrin. Thrombin exerts a number of additional biological actions, including platelet activation, amplification and self-inhibition of coagulation, clot stabilisation and anti-fibrinolysis, in processes occurring in the proximity of vessel injury, tightly regulated by a series of inhibitory mechanisms. "Classical" anticoagulants, including heparin and vitamin K antagonists, typically target multiple coagulation steps. A number of new anticoagulants, already developed or under development, target specific steps in the process, inhibiting a single coagulation factor or mimicking natural coagulation inhibitors.
- Published
- 2013
- Full Text
- View/download PDF
22. Dipyridamole decreases inflammatory metalloproteinase-9 expression and release by human monocytes.
- Author
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Massaro M, Scoditti E, Carluccio MA, Pellegrino M, Calabriso N, Storelli C, Martines G, and De Caterina R
- Subjects
- Cyclic AMP metabolism, Cyclic GMP metabolism, Dose-Response Relationship, Drug, Down-Regulation, Humans, I-kappa B Proteins metabolism, Matrix Metalloproteinase 9 genetics, Monocytes enzymology, Monocytes immunology, NF-KappaB Inhibitor alpha, RNA, Messenger metabolism, Signal Transduction drug effects, Time Factors, Tissue Inhibitor of Metalloproteinase-1 metabolism, Transcription Factor AP-1 metabolism, Transcription Factor RelA metabolism, Tumor Necrosis Factor-alpha metabolism, U937 Cells, p38 Mitogen-Activated Protein Kinases metabolism, Anti-Inflammatory Agents pharmacology, Dipyridamole pharmacology, Inflammation Mediators metabolism, Matrix Metalloproteinase 9 metabolism, Monocytes drug effects
- Abstract
Matrix metalloproteinase (MMP)-9 plays an important role in stroke by accelerating matrix degradation, disrupting the blood-brain barrier and increasing infarct size. Dipyridamole is an antiplatelet agent with recognised benefits in ischaemic stroke prevention. In addition to its antiplatelet properties, recent studies have reported that dipyridamole also features anti-inflammatory and anti-oxidant properties. We therefore investigated whether dipyridamole can ameliorate the proinflammatory profile of human monocytes, a source of MMP-9 in stroke, in terms of regulation of MMP-9 activity and expression, and explored underlying mechanisms. Human peripheral blood mononuclear cells (PBMC) and U937 cells were treated with increasing concentrations of dipyridamole (up to 10 µg/ml) for 60 minutes before stimulation with tumour necrosis factor (TNF)-α or phorbol myristate acetate (PMA). Exposure of PBMC and U937 to dipyridamole reduced TNF-α- and PMA-induced MMP-9 activity and protein release as well as MMP-9 mRNA, without significantly affecting the release of TIMP-1. This inhibitory effect was independent of dipyridamole-induced cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) increase. Correspondingly, dipyridamole also significantly inhibited TNF-α-induced nuclear factor (NF)-κB activation and nuclear translocation of the p65 NF-κB subunit through a mechanism involving the inhibition of IkBα degradation and p38 MAPK activation. In conclusion, dipyridamole, at therapeutically achievable concentrations, reduces the expression and release of MMP-9 through a mechanism involving p38 MAPK and NF-κB inhibition. These results indicate that dipyridamole exerts anti-inflammatory properties in human monocytes that may favourably contribute to its actions in the secondary prevention of stroke, independent of its antiplatelet properties.
- Published
- 2013
- Full Text
- View/download PDF
23. Measurements of thromboxane production and their clinical significance in coronary heart disease.
- Author
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Renda G and De Caterina R
- Subjects
- Female, Humans, Male, Acute Coronary Syndrome diagnosis, Aspirin therapeutic use, Biomarkers blood, Thromboxane A2 blood
- Published
- 2012
- Full Text
- View/download PDF
24. Hepatocyte growth factor: molecular biomarker and player in cardioprotection and cardiovascular regeneration.
- Author
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Madonna R, Cevik C, Nasser M, and De Caterina R
- Subjects
- Adult Stem Cells cytology, Animals, Apoptosis, Endothelial Cells cytology, Gene Expression Regulation, Heart Failure, Humans, Mice, Models, Biological, Myocardial Infarction metabolism, Neovascularization, Physiologic, Rats, Biomarkers metabolism, Cardiovascular Diseases metabolism, Cardiovascular System metabolism, Hepatocyte Growth Factor metabolism
- Abstract
The liver possesses impressive regenerative capacities. Grafts of embryonic liver explants and liver explant-conditioned media have been shown to enhance the mitotic activity of hepatocytes. Hepatocyte growth factor (HGF), also named scatter factor (SF), has been identified as a primary candidate in promoting and regulating liver regeneration. Although initially thought to be a liver-specific mitogen, HGF was later reported to have mitogenic, motogenic, morphogenic, and anti-apoptotic activities in various cell types. By promoting angiogenesis and inhibiting apoptosis, endogenous HGF may play an important role in cardioprotection as well as in the regeneration of endothelial cells and cardiomyocytes after myocardial infarction. Since serum concentration of HGF increases in the early phase of myocardial infarction and in heart failure, HGF may also play a key role as a prognostic and diagnostic biomarker of cardiovascular disease. Here we discuss the role of HGF as a biomarker and mediator in cardioprotection and cardiovascular regeneration.
- Published
- 2012
- Full Text
- View/download PDF
25. Contemporary use of glycoprotein IIb/IIIa inhibitors.
- Author
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Kristensen SD, Würtz M, Grove EL, De Caterina R, Huber K, Moliterno DJ, and Neumann FJ
- Subjects
- Abciximab, Acute Coronary Syndrome surgery, Animals, Antibodies, Monoclonal administration & dosage, Clinical Trials as Topic, Eptifibatide, Fibrinolytic Agents pharmacology, Humans, Immunoglobulin Fab Fragments administration & dosage, Peptides administration & dosage, Postoperative Complications etiology, Postoperative Complications prevention & control, Thrombosis prevention & control, Tirofiban, Tyrosine administration & dosage, Tyrosine analogs & derivatives, Acute Coronary Syndrome drug therapy, Angioplasty, Fibrinolytic Agents therapeutic use, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors, Thrombosis etiology
- Abstract
Platelet glycoprotein IIb/IIIa inhibitors (GPI) are antithrombotic agents preventing the binding of fibrinogen to GP IIb/IIIa receptors. Thus, GPI interfere with interplatelet bridging mediated by fibrinogen. Currently, three generic GPI with different antithrombotic properties are available for intravenous administration: abciximab, eptifibatide, and tirofiban. The development of oral GPI was abandoned, whereas intravenous GPI were introduced in various clinical settings during the 1990s, yielding substantial benefit in the treatment of acute coronary syndromes, particularly during percutaneous coronary interventions. Results of the many randomised trials evidenced the efficacy of this drug class, though these trials were conducted prior to the emergence of modern oral antiplatelet therapy with efficient P2Y(12) inhibitors. Subsequent trials failed to consolidate the strongly favourable impression of GPI, and indications for their use have been more restricted in recent years. Nonetheless, GPI may still be beneficial during coronary interventions among high-risk patients including acute ST-elevation and non-ST-elevation myocardial infarctions, particularly in the absence of adequate pretreatment with oral antiplatelet drugs or when direct thrombin inhibitors are not utilised. Intracoronary GPI administration has been suggested as adjunctive therapy during primary percutaneous coronary intervention, and the results of larger ongoing trials are expected to elucidate its clinical potential. The present review outlines the key milestones of GPI development and provides an up-to-date overview of the clinical applicability of these drugs in the era of refined coronary stenting, potent antithrombotic drugs, and novel thrombin inhibiting agents.
- Published
- 2012
- Full Text
- View/download PDF
26. Omega-3 fatty acids attenuate constitutive and insulin-induced CD36 expression through a suppression of PPAR α/γ activity in microvascular endothelial cells.
- Author
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Madonna R, Salerni S, Schiavone D, Glatz JF, Geng YJ, and De Caterina R
- Subjects
- Androstadienes pharmacology, Anilides pharmacology, CD36 Antigens genetics, Calcium-Calmodulin-Dependent Protein Kinases antagonists & inhibitors, Cell Line, Dermis pathology, Endothelial Cells drug effects, Endothelial Cells pathology, Flavonoids pharmacology, Humans, Insulin pharmacology, Insulin Resistance physiology, Oxidative Stress, PPAR alpha antagonists & inhibitors, PPAR gamma antagonists & inhibitors, Phosphoinositide-3 Kinase Inhibitors, Receptors, Scavenger genetics, Wortmannin, CD36 Antigens metabolism, Endothelial Cells metabolism, Fatty Acids, Omega-3 metabolism, Gene Expression Regulation drug effects, Receptors, Scavenger metabolism
- Abstract
Microvascular dysfunction occurs in insulin resistance and/or hyperinsulinaemia. Enhanced uptake of free fatty acids (FFA) and oxidised low-density lipoproteins (oxLDL) may lead to oxidative stress and microvascular dysfunction interacting with CD36, a PPARα/γ-regulated scavenger receptor and long-chain FFA transporter. We investigated CD36 expression and CD36-mediated oxLDL uptake before and after insulin treatment in human dermal microvascular endothelial cells (HMVECs), ± different types of fatty acids (FA), including palmitic, oleic, linoleic, arachidonic, eicosapentaenoic (EPA), and docosahexaenoic (DHA) acids. Insulin (10(-8) and 10(-7) M) time-dependently increased DiI-oxLDL uptake and CD36 surface expression (by 30 ± 13%, p<0.05 vs. untreated control after 24 hours incubation), as assessed by ELISA and flow cytometry, an effect that was potentiated by the PI3-kinase inhibitor wortmannin and reverted by the ERK1/2 inhibitor PD98059 and the PPARα/γ antagonist GW9662. A ≥ 24 hour exposure to 50 μM DHA or EPA, but not other FA, blunted both the constitutive (by 23 ± 3% and 29 ± 2%, respectively, p<0.05 for both) and insulin-induced CD36 expressions (by 45 ± 27 % and 12 ± 3 %, respectively, p<0.05 for both), along with insulin-induced uptake of DiI-oxLDL and the downregulation of phosphorylated endothelial nitric oxide synthase (P-eNOS). At gel shift assays, DHA reverted insulin-induced basal and oxLDL-stimulated transactivation of PPRE and DNA binding of PPARα/γ and NF-κB. In conclusion, omega-3 fatty acids blunt the increased CD36 expression and activity promoted by high concentrations of insulin. Such mechanisms may be the basis for the use of omega-3 fatty acids in diabetic microvasculopathy.
- Published
- 2011
- Full Text
- View/download PDF
27. Understanding the complexity of abciximab-related thrombocytopenia.
- Author
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De Caterina R and Zimarino M
- Subjects
- Abciximab, Acute Coronary Syndrome complications, Acute Coronary Syndrome drug therapy, Humans, Thrombocytopenia immunology, Antibodies, Monoclonal adverse effects, Immunoglobulin Fab Fragments adverse effects, Thrombocytopenia chemically induced
- Published
- 2010
- Full Text
- View/download PDF
28. Prolonged exposure to high insulin impairs the endothelial PI3-kinase/Akt/nitric oxide signalling.
- Author
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Madonna R and De Caterina R
- Subjects
- Cell Adhesion, E-Selectin metabolism, Endothelial Cells drug effects, Enzyme Inhibitors pharmacology, Humans, Intercellular Adhesion Molecule-1 metabolism, Monocytes metabolism, NG-Nitroarginine Methyl Ester pharmacology, Nitric Oxide Synthase Type III antagonists & inhibitors, Nitric Oxide Synthase Type III metabolism, Phosphorylation, Recombinant Proteins metabolism, Time Factors, Tumor Necrosis Factor-alpha metabolism, U937 Cells, Vascular Cell Adhesion Molecule-1 metabolism, Endothelial Cells enzymology, Hyperinsulinism enzymology, Insulin metabolism, Nitric Oxide metabolism, Phosphatidylinositol 3-Kinases metabolism, Proto-Oncogene Proteins c-akt metabolism, Signal Transduction drug effects
- Abstract
Hyperinsulinemia predicts future cardiovascular events, but may also contribute to atherosclerosis. We therefore studied the consequences of prolonged insulin treatment of human umbilical vein endothelial cells (HUVEC) on the phosphatidylinositol-3'-kinase(PI3K)/Akt/nitric oxide(NO)-dependent insulin signaling, together with the expression of the pro-atherogenic molecule vascular cell adhesion molecule (VCAM)-1. HUVEC were incubated with insulin (10(-11) to 10(-7) M) in short- (30 min) and long-term (24 h to 3 days) incubations. In short-term incubations, insulin did not affect constitutive Akt and eNOS at any concentration, but significantly increased their active phosphorylated forms, and NO production. In long-term incubations, however, such insulin effects on the phosphorylated forms, as well as NO production, were attenuated, promoting an effect of insulin also at concentrations otherwise ineffective. Such effects were accompanied by a boosting of insulin effect on VCAM-1 surface expression. In contrast, under similar conditions, insulin did not exert any significant effect on the surface expression of ICAM-1 and E-selectin. Therefore, prolonged exposure of HUVEC to high insulin levels induces a downregulation of the PI3K/Akt/eNOS axis. Such impairment of insulin signalling in states of prolonged hyperinsulinemia pontially contributes to detrimental effects on atherogenesis in insulin resistance states, such as the metabolic syndrome and type 2 diabetes.
- Published
- 2009
29. Drug-eluting balloons for percutaneous coronary interventions.
- Author
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Zimarino M and De Caterina R
- Subjects
- Angioplasty, Balloon, Coronary adverse effects, Animals, Cell Proliferation drug effects, Coronary Stenosis etiology, Coronary Stenosis pathology, Coronary Vessels pathology, Equipment Design, Humans, Metals, Models, Animal, Stents, Sus scrofa, Angioplasty, Balloon, Coronary instrumentation, Cardiovascular Agents administration & dosage, Coated Materials, Biocompatible, Coronary Stenosis prevention & control, Coronary Vessels drug effects, Paclitaxel administration & dosage
- Published
- 2009
30. The prostacyclin analogue iloprost increases circulating endothelial progenitor cells in patients with critical limb ischemia.
- Author
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Di Stefano R, Barsotti MC, Melillo E, Iorio M, Santoni T, Armani C, Dell'omodarme M, Ristori C, De Caterina R, and Balbarini A
- Subjects
- Aged, Aged, 80 and over, Angiogenesis Inducing Agents administration & dosage, Carbon Dioxide blood, Cells, Cultured, Critical Illness, Endothelial Cells pathology, Female, Humans, Iloprost administration & dosage, Infusions, Intravenous, Intermittent Claudication drug therapy, Intermittent Claudication etiology, Ischemia complications, Ischemia metabolism, Ischemia pathology, Male, Oxygen blood, Stem Cells pathology, Treatment Outcome, Vascular Endothelial Growth Factor A blood, Angiogenesis Inducing Agents therapeutic use, Endothelial Cells drug effects, Extremities blood supply, Iloprost therapeutic use, Ischemia drug therapy, Stem Cells drug effects
- Abstract
Patients with critical limb ischemia (CLI) have low levels of endothelial progenitor cells (EPC). Iloprost has been demonstrated to stimulate vascular endothelial growth factor (VEGF) and promote angiogenesis. We investigated the effects of iloprost on EPC levels in vivo in CLI patients. Twenty-three patients with stage III and IV CLI were treated with iloprost for four weeks, improving clinical and instrumental parameters. Mononuclear cells isolated from peripheral blood were cultured to obtain "early" EPC, evaluated counting adherent cells with double positivity for acetylated low-density lipoprotein uptake and Ulex Europaeus lectin at flow cytometry. These cells also co-expressed the monocyte markers CD14 and CD45. Iloprost increased EPC number in the whole patient population: pre-treatment median: 13,812/ml; range: 1,263-83,648/ml; post-treatment median: 23,739/ml; range: 3,385-99,251/ml; p = 0.035, irrespective of age, sex, disease stage or atherosclerosis risk factors. In conclusion, iloprost increases EPC number in peripheral blood in vivo. Such an effect may have therapeutic relevance.
- Published
- 2008
31. The C242T polymorphism of the p22phox component of NAD(P)H oxidase and vascular risk. Two case-control studies and a meta-analysis.
- Author
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Di Castelnuovo A, Soccio M, Iacoviello L, Evangelista V, Consoli A, Vanuzzo D, Diviacco S, Carluccio M, Rignanese L, and De Caterina R
- Subjects
- Aged, Asian People genetics, Cardiovascular Diseases enzymology, Cardiovascular Diseases ethnology, Case-Control Studies, Coronary Artery Disease enzymology, Coronary Artery Disease ethnology, Female, Gene Frequency, Genetic Predisposition to Disease, Humans, Italy, Male, Middle Aged, NADPH Oxidases metabolism, Odds Ratio, Reactive Oxygen Species metabolism, Risk Assessment, Risk Factors, White People genetics, Cardiovascular Diseases genetics, Coronary Artery Disease genetics, NADPH Oxidases genetics, Polymorphism, Genetic
- Abstract
NAD(P)H oxidase is a prominent source of reactive oxygen species in the vasculature. Vascular NAD(P)H oxidase is comprised of several subunits, one of which, p22phox, is encoded by a gene exhibiting several allelic variants. Here the C(242)T nucleotide transition has been found to alter superoxide anion production and associated with an altered risk of coronary artery disease (CAD). We assessed the role of this variant in two case-control studies, and performed a meta-analysis of previously reported investigations relating it to vascular risk. Population I was comprised of 492 subjects with type 2 diabetes, with or without macrovascular disease, matched for age, sex, and duration of diabetes. Population II was comprised of 158 subjects with or without either CAD or cerebro-vascular disease, and matched for age, sex, smoking status, weight category and the presence of hypertension, dyslipidemia, and diabetes. Our findings were meta-analyzed together with additional studies retrieved from the literature. The C(242)T polymorphism distribution did not differ between cases and controls in populations I and II both at univariate and multivariate analyses, and this was confirmed in a meta-analysis with 11 previously published populations. The meta-analysis, however, suggested a protective role of the T allele on CAD as an end point in Asian populations. In conclusion, these data suggest a significant heterogeneity for a modulating role of the T allele in the C(242)T polymorphism of p22-phox for the occurrence of CAD across ethnicities, with the absence of a significant effect in Caucasians.
- Published
- 2008
- Full Text
- View/download PDF
32. Parallel decrease of tissue factor surface exposure and increase of tissue factor microparticle release by the n-3 fatty acid docosahexaenoate in endothelial cells.
- Author
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Del Turco S, Basta G, Lazzerini G, Evangelista M, Rainaldi G, Tanganelli P, Camera M, Tremoli E, and De Caterina R
- Subjects
- Cells, Cultured, Endothelium, Vascular cytology, Fatty Acids, Omega-3 pharmacology, Humans, Lipopolysaccharides, Membrane Proteins metabolism, Tumor Necrosis Factor-alpha, Umbilical Veins cytology, Docosahexaenoic Acids pharmacology, Endothelial Cells physiology, Thromboplastin metabolism
- Abstract
Tissue factor (TF) is expressed on the endothelium in response to inflammatory mediators, giving endothelial cells a pro-thrombotic phenotype. Since fish-derived n-3 fatty acids (FA) have been associated with reduced incidence of myocardial infarction, we investigated the endothelial effects of the most abundant n-3 FA, docosahexaenoate (DHA), on TF expression. Human umbilical vein endothelial cells were pre-incubated with DHA (or stearate and arachidonate as controls) for 48-72 hours, and then stimulated with bacterial lipopolysaccharide (LPS) or tumor necrosis factor-alpha. Pre-incubation of endothelial cells with DHA (but not stearate or arachidonate) concentration-dependently reduced surface protein exposure, independent of TF mRNA or total protein expression regulation. Conversely, DHA treatment in conjunction with activating stimuli, induced the release of endothelial TF-exposing microparticles from endothelial cells, quantitatively accounting for the decreased TF cell surface exposure. In conclusion, DHA treatment, with a time-course consistent with its incorporation in membrane phospholipids, increases the release of TF-exposing microparticles from endothelial cells, accounting for decreased endothelial cell TF surface exposure, thus potentially modifying the overall endothelial control of microparticle-related effects.
- Published
- 2007
33. Distal embolization during angioplasty for acute myocardial infarction: is pharmacological protection enough?
- Author
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De Carlo M, Limbruno U, Pistolesi S, Fontanini G, Petronio AS, Balbarini A, and De Caterina R
- Subjects
- Abciximab, Coronary Vessels, Embolism etiology, Female, Humans, Male, Middle Aged, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors, Angioplasty, Balloon, Coronary adverse effects, Antibodies, Monoclonal therapeutic use, Embolism prevention & control, Immunoglobulin Fab Fragments therapeutic use, Myocardial Infarction therapy, Thrombolytic Therapy
- Published
- 2005
- Full Text
- View/download PDF
34. Late coronary thrombosis after drug-eluting stent: stent vs patient-driven prescription of aspirin-clopidogrel combination.
- Author
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Zimarino M, Renda G, Maddestra N, and De Caterina R
- Subjects
- Clopidogrel, Drug Therapy, Combination, Female, Humans, Middle Aged, Practice Guidelines as Topic, Time Factors, Aspirin administration & dosage, Coronary Thrombosis etiology, Stents adverse effects, Ticlopidine administration & dosage, Ticlopidine analogs & derivatives
- Published
- 2004
35. Quenching of intracellular ROS generation as a mechanism for oleate-induced reduction of endothelial activation and early atherogenesis.
- Author
-
Massaro M, Basta G, Lazzerini G, Carluccio MA, Bosetti F, Solaini G, Visioli F, Paolicchi A, and De Caterina R
- Subjects
- Arteriosclerosis etiology, Catalase analysis, Cytokines pharmacology, Endothelium, Vascular metabolism, Endothelium, Vascular pathology, Glutathione analysis, Humans, Lipopolysaccharides pharmacology, Superoxide Dismutase analysis, Vascular Cell Adhesion Molecule-1 analysis, Vascular Cell Adhesion Molecule-1 drug effects, Arteriosclerosis prevention & control, Endothelium, Vascular drug effects, Oleic Acid pharmacology, Reactive Oxygen Species metabolism
- Abstract
We previously showed that the exposure of vascular endothelium to oleate results in reduced endothelial activation. We now investigate possible mechanisms for this effect in relation to generation of reactive oxygen species (ROS). We stimulated several types of endothelial cells with cytokines or lipopolysaccharide, with or without preincubation with 10-100 mumol/L oleate. Oleate preincubation reduced VCAM-1 expression in all cell types, as well as macrophage-colony stimulating factor release. We simultaneously measured the concentration of intracellular glutathione (GSH), the activity of GSH-related antioxidant enzymes and the production of intracellular ROS. Stimulation of endothelial cells caused a decrease of GSH and an increase in intracellular ROS. The addition of oleate before stimulation, prevented the depletion of GSH and partially prevented stimuli-induced increase of intracellular ROS. This occurred without any change in the activity of GSH-related antioxidant enzymes, superoxide dismutase and catalase. Furthermore, in a cell-free superoxide anion-generating system, oleate quenched the generation of ROS. These results indicate that oleate may exert direct vascular atheroprotective effects by inhibiting endothelial activation through a quenching of stimuli-induced increase in ROS.
- Published
- 2002
36. Platelet-vessel wall interactions with third-generation oral contraceptives: no evidence of detrimental effects.
- Author
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Fruzzetti F, Giannessi D, Ricci C, Bernini W, Puntoni R, Genazzani AR, and De Caterina R
- Subjects
- 6-Ketoprostaglandin F1 alpha urine, Adolescent, Adult, Blood Platelets physiology, Blood Vessels physiology, Female, Humans, Risk Factors, Smoking adverse effects, Thrombosis etiology, Thromboxane B2 analogs & derivatives, Thromboxane B2 urine, Blood Platelets drug effects, Blood Vessels drug effects, Contraceptives, Oral adverse effects
- Abstract
Because of the association of oral contraceptives (OC) and cigarette smoking with an increased thrombotic risk, we evaluated thromboxane (TX) and prostacyclin urinary (u) metabolites, as in vivo indices of platelet-vessel wall interactions, in women assigned to third generation OC. Twenty-eight women (15 smokers) underwent a 6-month trial of 30 microg ethinylestradiol plus 0.150 mg desogestrel. Cotinine plasma levels were elevated only in persons classified as smokers and serum TXB2 determination confirmed the absence of cyclooxygenase inhibition throughout the study. u-TXB2 and 11-dehydro-TXB2 were higher in smokers than in non-smokers. OC decreased u-11-dehydro-TXB2 both in smokers (from (pg/micromol creatinine) 35.1+/-6.9 to 15.8+/-2.8; P<0.025) and non-smokers (from 31.7+/-9.8 to 20.6+/-4.8, P = N.S.). u-6-keto-prostaglandin(PG)F1alpha excretion, also higher in smokers compared to non-smokers, was also reduced after OC in smokers (from (pg/micromol creatinine) 24.3+/-5.2 to 14.8+/-2.3; P<0.05). Smokers also had a trend to higher u-2,3-dinor-6-keto-PGF1alpha, marginally reduced by OC. Thus, the OC regimen used here improves - if anything - platelet vessel wall interactions as assessed by prostanoid production in vivo. The prothrombotic tendency associated with the use of OC in smokers does not appear to be mediated by changes in platelet-vessel wall interactions.
- Published
- 1999
37. A cost-effectiveness analysis of aspirin versus oral anticoagulants after acute myocardial infarction in Italy -- equivalence of costs as a possible case for oral anticoagulants.
- Author
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Gianetti J, Gensini G, and De Caterina R
- Subjects
- Administration, Oral, Anticoagulants adverse effects, Anticoagulants therapeutic use, Aspirin adverse effects, Aspirin therapeutic use, Blood Coagulation Tests economics, Coronary Disease drug therapy, Cost-Benefit Analysis, Drug Costs, Fibrinolytic Agents adverse effects, Fibrinolytic Agents therapeutic use, Health Policy, Hemorrhage chemically induced, Hemorrhage economics, Humans, Italy epidemiology, Myocardial Infarction epidemiology, National Health Programs economics, Platelet Aggregation Inhibitors adverse effects, Platelet Aggregation Inhibitors therapeutic use, Recurrence, Warfarin adverse effects, Warfarin therapeutic use, Anticoagulants economics, Aspirin economics, Coronary Disease economics, Fibrinolytic Agents economics, Myocardial Infarction drug therapy, Platelet Aggregation Inhibitors economics, Warfarin economics
- Abstract
Aims: The recent publication of two large trials of secondary prevention of coronary artery disease with oral anticoagulants (WARIS and ASPECT) has caused a revival of the interest for this antithrombotic therapy in a clinical setting where the use of aspirin is common medical practice. Despite this, the preferential use of aspirin has been supported by an American cost-effectiveness analysis (JAMA 1995; 273: 965)., Methods and Results: Using the same parameters used in that analysis and incidence of events from the Antiplatelet Trialists Collaboration and the ASPECT study, we re-evaluated the economic odds in favor of aspirin or oral anticoagulants in the Italian Health System, which differs significantly in cost allocation from the United States system and is, conversely, similar to other European settings. Recalculated costs associated with each therapy were 2,150 ECU/ patient/year for oral anticoagulants and 2,187 ECU/patient/year for aspirin. In our analysis, the higher costs of oral anticoagulants versus aspirin due to a moderate excess of bleeding (about 10 ECU/ patient/year) and the monitoring of therapy (168 ECU/ patient/year) are more than offset by an alleged savings for recurrent ischemic syndromes and interventional procedures (249 ECU/ patient/year)., Conclusions: Preference of aspirin vs. oral anticoagulants in a pharmaco-economical perspective is highly dependent on the geographical situation whereupon calculations are based. On a pure cost-effectiveness basis, and in the absence of data of direct comparisons between aspirin alone versus I.N.R.-adjusted oral anticoagulants, the latter are not more expensive than aspirin in Italy and, by cost comparisons, in other European countries in the setting of post-myocardial infarction.
- Published
- 1998
38. A prostacyclin-sparing effect of indobufen vs. aspirin.
- Author
-
De Caterina R, Giannessi D, Bernini W, Lazzerini G, Lavezzari M, Stragliotto E, Biagi G, and Coccheri S
- Subjects
- Adult, Cross-Over Studies, Double-Blind Method, Humans, Isoindoles, Male, Middle Aged, Prospective Studies, Prostaglandins biosynthesis, Reference Values, Aspirin pharmacology, Cyclooxygenase Inhibitors pharmacology, Epoprostenol biosynthesis, Phenylbutyrates pharmacology, Platelet Aggregation Inhibitors pharmacology
- Abstract
Indobufen ((+/-)-2-[p-(1-oxo-2-insoindolinyl)-phenyl]-butyric acid, indo) is a drug inhibiting platelet function by a reversible block of the arachidonic acid metabolism at the level of cyclooxygenase. Since tolerability profile of such drugs is mostly linked to extra-platelet cyclooxygenase inhibition, we prospectively evaluated the extent of platelet and extra-platelet cyclooxygenase inhibition by in vivo administration of indo in comparison with ASA. We assessed the effects of the two drugs on the ex vivo generation of TXB2 and 6-keto-PGF1 alpha in whole blood, as indices of the production of TXA2 and PGI2 (prostacyclin), respectively, either after spontaneous clotting at 37 degrees C for 1 h (Study 1) or after the addition of 2 micrograms/ml collagen (Study 2). Generation of 6-keto-PGF1 alpha in whole blood is a mixed index of platelet and extra-platelet cyclooxygenase activity, deriving from both platelet and white blood cell arachidonic acid metabolization. Fifteen patients with ischemic heart disease and baseline serum TXB2 levels > 300 ng/ml were allocated to receiving one single administration of either indobufen 200 mg (n = 6) or aspirin 500 mg (n = 9). Whole blood prostanoid generation was assessed at 0, 1, 2, 4, 6, 8, 12 and 24 h after drug administration (Study I). Ten healthy male volunteers were allocated to a double-blind, randomized crossover comparison of indo 200 mg b.i.d. vs. ASA 300 mg/d for 7 days (Study 2). Prostanoid generation and whole blood platelet aggregation were performed before and at the end of each study period (Day 0 and Day 7). At each time-point after single dose administration (Study 1), indobufen caused less % inhibition of whole blood 6-keto-PGF1 alpha than of TXB2. At 2 h, TXB2 was reduced to a similar extent after ASA (98 +/- 4%) and indo (97 +/- 6%) (p = N.S.), while inhibition of 6-keto-PGF1 alpha was clearly different ( > 98% after ASA, 81 +/- 2.5% after indo, p < 0.01). After one week of ASA or indo (Study 2) the maximum extent of whole blood platelet aggregation was similarly inhibited (from 17.2 +/- 1.4 ohms to 3.6 +/- 1.3 ohms with ASA; from 18.3 +/- 1.0 ohms to 1.6 +/- 0.7 ohms with indo (p ASA vs. indo = N.S.). Despite equal inhibition of whole blood TX production after collagen (from 49.0 +/- 4.3 ng/ml to 1.1 +/- 0.6 ng/ml with ASA, from 49.8 +/- 1.3 ng/ml to 1.4 +/- 0.6 ng/ml with indo), again, however, 6-keto-PGF1 alpha production was less affected by indo than by ASA (from 409 +/- 30 pg/ml to 37 +/- 13 pg/ml with ASA, inhibition = 91%; from 396 +/- 35 to 318 +/- 40 with indo, inhibition = 20%). These differential effects of indo and ASA might lead to a better platelet selectivity, tolerability and benefit/risk profile of indo vs. ASA, which are worthy of further assessment.
- Published
- 1996
39. The d-enantiomer form of indobufen totally accounts for the anti-cyclooxygenase and antiplatelet activity ex vivo and for the increase in bleeding time by indobufen in man.
- Author
-
De Caterina R, Sicari R, Yan A, Bernini W, Giannessi D, Lazzerini G, Efthymiopoulos C, and Strolin-Benedetti M
- Subjects
- Aged, Bleeding Time, Coronary Disease metabolism, Cyclooxygenase Inhibitors pharmacokinetics, Cyclooxygenase Inhibitors pharmacology, Double-Blind Method, Female, Humans, Isoindoles, Male, Middle Aged, Phenylbutyrates pharmacokinetics, Phenylbutyrates pharmacology, Platelet Aggregation Inhibitors pharmacokinetics, Platelet Aggregation Inhibitors pharmacology, Prospective Studies, Stereoisomerism, Coronary Disease drug therapy, Cyclooxygenase Inhibitors chemistry, Phenylbutyrates chemistry, Platelet Aggregation Inhibitors chemistry
- Abstract
Indobufen is an antiplatelet drug able to inhibit thromboxane production and cyclooxygenase-dependent platelet aggregation by a reversible inhibition of cyclooxygenase. Indobufen exists in two enantiomeric forms, of which only d-indobufen is active in vitro in inhibiting cyclooxygenase. In order to verify that also inhibition of platelet function is totally accounted for by d-indobufen, ten patients with proven coronary artery disease (8 male, 2 female, age, mean +/- S.D., 58.7 +/- 7.5 years) were given, in random sequence, both 100 mg d-indobufen and 200 mg dl-indobufen as single administrations in a double-blind crossover design study with a washout period between treatments of 72 h. In all patients thromboxane (TX) B2 generation after spontaneous clotting (at 0, 1, 2, 4, 6, 8, 12, 24 h), drug plasma levels (at the same times), platelet aggregation in response to ADP, adrenaline, arachidonic acid, collagen, PAF, and bleeding time (at 0, 2, 12 h) were evaluated after each treatment. Both treatments determined peak inhibition of TXB2 production at 2 h from administration, with no statistical difference between the two treatments (97 +/- 3% for both treatments). At 12 h inhibition was 87 +/- 6% for d-indobufen and 88 +/- 6% for dl-indobufen (p = NS). Inhibition of TXB2 production correlated significantly with plasma levels of the drugs.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1992
40. Benefit/risk profile of combined antiplatelet therapy with ticlopidine and aspirin.
- Author
-
De Caterina R, Sicari R, Bernini W, Lazzerini G, Buti Strata G, and Giannessi D
- Subjects
- Aged, Bleeding Time, Drug Synergism, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Risk Factors, Thromboxane B2 blood, Aspirin administration & dosage, Platelet Aggregation Inhibitors administration & dosage, Ticlopidine administration & dosage
- Abstract
Ticlopidine (T) and aspirin (ASA) are two antiplatelet drugs both capable of prolonging bleeding time (BT), with a different mechanism of action. A synergism in BT prolongation has been reported and is currently considered an argument for not recommending their combination. However, a profound suppression of platelet function might be a desirable counterpart of a marked prolongation of BT, with a possible use in selected clinical situations. We therefore studied ex vivo platelet function (aggregation by ADP 0.5-1-2.5 microM; adrenaline 0.75-2.5 microM; collagen 1.5-150 micrograms/ml; arachidonic acid 1 mM; PAF 1 microM; adrenaline 0.17 microM + ADP 0.62 microM; serum thromboxane [( TX]B2 generation) and BT (Mielke) in 6 patients with stable coronary artery disease receiving such combination. Patients underwent sequential laboratory evaluations at baseline, after 7 days of T 250 mg b.i.d., before and after the intravenous administration of ASA 500 mg, respectively, and, finally, after a minimum of 7 days of sole ASA oral administration (50 mg/day). The experimental design, therefore, allowed a comparison of T and ASA effects (2nd and 4th evaluation), and an assessment of the combination effect (3rd evaluation). Platelet aggregation in response to all doses of ADP was depressed more by T than by ASA. Conversely, responses to adrenaline, and arachidonate were affected more by ASA than by T. For all other agents, differences were not significant. T + ASA combination was more effective (p less than 0.05) than either treatment alone in depressing responses to high-dose collagen (% over control, mean +/- SEM: T: 95 +/- 3; ASA: 96 +/- 5; T + ASA: 89 +/- 4).(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1991
41. Organic nitrates: direct antiplatelet effects and synergism with prostacyclin. Antiplatelet effects of organic nitrates.
- Author
-
De Caterina R, Giannessi D, Bernini W, and Mazzone A
- Subjects
- Adult, Blood Platelets physiology, Drug Synergism, Female, Humans, In Vitro Techniques, Isosorbide Dinitrate analogs & derivatives, Isosorbide Dinitrate pharmacology, Male, Platelet Aggregation drug effects, Thromboxane B2 blood, Blood Platelets drug effects, Epoprostenol pharmacology, Nitrates pharmacology
- Abstract
Isosorbide dinitrate inhibits platelet function in vivo at concentrations about 10 times lower than in vitro (10(-7)-10(-6) vs. 10(-6)-10(-5) M). We investigated two possible reasons for this difference. Isosorbide dinitrate and its in vivo longer-lived metabolites, isosorbide-2- and isosorbide-5-mononitrate were incubated for 5 min with human platelet-rich plasma or washed platelets; irreversible aggregation was induced with threshold doses of ADP, adrenaline, collagen, arachidonic acid and thrombin, and thromboxane (TX) B2 production was measured by radioimmunoassay. Moreover, the concentration of exogenous prostacyclin required to inhibit platelet aggregation by 50% (IC50) after preincubation with isosorbide dinitrate or vehicle was determined. At 10(-7) M, only isosorbide-2-mononitrate inhibited aggregation (-12%, p less than 0.05) and TX production (-36%, p less than 0.01) by ADP. At 10(-6) M isosorbide-2-mononitrate inhibited aggregation by adrenaline more than the dinitrate (-41% vs. -25%, p less than 0.05). In addition, at supra-threshold doses of all the aggregating agents, isosorbide dinitrate decreased IC50 of prostacyclin from 2.7 +/- 1.2 to 0.36 +/- 0.2 nM. Generation of a platelet-active metabolite and synergism with prostacyclin are new properties of isosorbide dinitrate that may account for antiplatelet effects in vivo.
- Published
- 1988
42. Modulation of arachidonic acid metabolism in human endothelial cells by glucocorticoids.
- Author
-
De Caterina R and Weksler BB
- Subjects
- Arachidonic Acid, Cells, Cultured, Cycloheximide pharmacology, Dinoprostone, Endothelium drug effects, Endothelium metabolism, Epoprostenol biosynthesis, Humans, Hydrocortisone pharmacology, Kinetics, Prostaglandins biosynthesis, Prostaglandins E biosynthesis, Umbilical Veins drug effects, Arachidonic Acids metabolism, Dexamethasone pharmacology, Umbilical Veins metabolism
- Abstract
To learn whether glucocorticoids inhibit prostaglandin (PG) production in vascular endothelial cells, we investigated the effects of glucocorticoids on PG synthesis by cultured human umbilical vein endothelial cells (EC). Pretreatment of EC with dexamethasone (DX, 10(-9) to 5 X 10(-5) M) caused a dose-dependent inhibition of PGI2 production when PG synthesis from endogenous arachidonate was stimulated by human thrombin (0.25-2 U/ml) or ionophore A 23187 (1-5 microM). The inhibition was detectable at 10(-7) M DX and maximal at 10(-5) M (4.0 +/- 0.7 vs. control: 7.7 +/- 1.9 ng/ml, mean +/- S.D., P less than 0.01). The production of PGE2 and the release of radiolabelled arachidonate (AA) from prelabelled cells were similarly inhibited. Prolonged incubation of EC with glucocorticoids was required to inhibit PG production or arachidonate release: ranging from 8% inhibition at 5 h to 44% at 38 h. In contrast, prostaglandin formation from exogenous AA was not altered by DX treatment. When thrombin or ionophore-stimulated EC were restimulated with exogenous AA (25 microM), DX-treated cells released more PGI2 than control cells (5.7 +/- 0.5 vs. 4.1 +/- 0.6 ng/ml, P less than 0.01). Both the decrease in PGI2 production after thrombin/ionophore and the increase after re-stimulation with AA were blunted in the presence of the protein synthesis inhibitor cycloheximide (0.1-0.2 micrograms/ml). Thus, incubation of EC with glucocorticoids inhibits PG production at the step of phospholipase activation. The time requirement for these steroid effects and their blunting by cycloheximide are consistent with the induction of regulatory proteins, possibly lipocortins, in endothelial cells.
- Published
- 1986
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