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Background: Antiplatelet therapy (APT) is the cornerstone for cardiovascular (CV) prevention in patients with coronary artery disease (CAD). However, there is potential for greater effectiveness in vascular prevention for patients with stable CAD or peripheral artery disease (PAD) through the use of rivaroxaban alone or in combination with aspirin, surpassing the benefits offered by aspirin alone. Materials and Methods: INdian Real world EvidenCe Of Rivaroxaban use in coronary artery Disease - A prospective observational cohort study (INRECORD) study is designed as a prospective, observational study. The objective of this study is to compare the real-world effectiveness and safety of rivaroxaban in combination with APT (dual pathway inhibition therapy [DPIT]) versus dual APT (DAPT) in Indian patients with CAD and peripheral arterial disease (PAD). The study will encompass multiple clinical sites across the Indian geography. The study's primary outcome is the comparison of net clinical benefit between the two groups which is defined as the composite of effectiveness (reduction in incidence of CV death, stroke, and myocardial infarction [MI]) and safety (life-threatening or fatal bleeding). Results: From June 2021 to December 2022, we enrolled 374 patients from the participating sites from India. We enrolled 225 and 149 patients in the DAPT and DPIT groups, respectively. The mean observed age and weight at the baseline were 63.05 ± 10.09 years and 64.15 ± 11.43 kg, respectively. There was a male preponderance observed in the enrolled patients (males: 86.63%, females: 13.37%). The most frequent comorbidity observed in CAD patients was hypertension, followed by diabetes and MI. At baseline, a significant percentage of patients were taking antiplatelet medications besides aspirin. Conclusion: IN-RECORD will provide information on the efficacy and safety of rivaroxaban in combination with APT versus APT in the Indian patient population in real-life clinical scenario. [ABSTRACT FROM AUTHOR]

Ticagrelor is a potent, oral P2Y12 inhibitor used as a part of dual antiplatelet therapy (DAPT) in acute coronary syndromes (ACS). New evidence has emerged for its use in ACS, which may be crucial for the Indian context. This brought together nearly 150 experts in ACS management across the country who reviewed the current evidence and discussed the same through a series of 10 meetings on an online platform. With all experts' agreement, the key expert opinions for the P2Y12 inhibitors use in ACS management were finalized. These include the following. In ACS patients aged <75 years, with diabetes, a history of stroke/transient ischemic attack, and chronic kidney disease, ticagrelor may be preferred over other P2Y12 inhibitors. It may also be preferred in the elderly above 75 years with clopidogrel is a suitable alternative in patients at high-risk of bleeding. Rates of stent thrombosis are lower with ticagrelor than clopidogrel. In patients managed with fibrinolysis, use ticagrelor after 48 hours if streptokinase was the fibrinolytic agent or it can be used after 12 to 24 hours if fibrin-specific fibrinolytic was used. Rates of major bleeding in patients treated with fibrinolysis are similar to clopidogrel. Prehospital administration may be preferred over in-hospital administration with expected bleeding rates similar to clopidogrel. Switching among P2Y12 inhibitors should be done with due consideration of their pharmacodynamics. At present, DAPT should be continued for 12 months with discontinuation after three to six months in patients with high bleeding risk. The use of low dose ticagrelor may be considered in cases with high-bleeding risk. DAPT or ticagrelor continuation beyond one year should be individualized considering ischemic and bleeding risks. Dyspnea is a common, mild, and transient and does not necessitate ticagrelor discontinuation. Severe dyspnea should be investigated thoroughly. In conclusion, ticagrelor (180 mg, 90 mg, and 60 mg doses), a potent antiplatelet is expected to reshape the antiplatelet use in the management of ACS., (© Journal of the Association of Physicians of India 2011.)

Objectives: This study aims to assess the safety and efficacy of a biodegradable polymer-coated Rapamycin-Eluting Stent (Excel) used in conjunction with six-month dual antiplatelet therapy in daily practice., Background: The polymeric material of cardiac stents has been reported to adversely affect the safety profile of the drug-eluting stents and is also suspected to cause serious long-term complications. It has been proposed that the biodegradable polymer coatings may reduce such late-stage adverse effects., Methods: This is a prospective, multi-center registry of 654 patients from across 9 cardiology centers in India, who were enrolled and exclusively treated with Excel stents between February 2008 and May 2010. The recommended antiplatelet regimen included clopidogrel and aspirin for 6 months period, followed by lifelong aspirin therapy., Results: The study population included 46.94% diabetics, 24.31% smokers, 48.93% hypertensives and 14.98% hyperlipidemics. The cumulative rates of major adverse cardiac events were 0.153% at discharge and 1.38% at 12 months. The mean percentage of stenosis was 88.24 ± 9.17% No events occurred between 6 and 12 months., Conclusions: This multi-center registry study on "real world, all comers" has, thus, showed that EXCEL™ stent which is PLA-coated biodegradable Rapamycin-Eluting Stent exhibited high efficacy and safety profile in treatment of patients undergoing PCI as evidenced by significantly lower rates of MACE and no case of stent thrombosis. There was no event even after DAPT was discontinued after 6 months., (Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)