An Battle vs BI-1356 (-)-MK 801 And How To Dominate It

ts receiving VKA therapy, consequently,will need typical coagulation monitoring and dose adjustment.Therefore, VKAs are frequently underused within the clinical setting. Forexample, a retrospective US cohort study of hospitalized patientswith AFfound that, despite the fact that 86% of patients wereclassed as being at high risk of stroke, only 55% were offered aVKA.21 Far more surprisingly, 21% of high-risk (-)-MK 801 patients did notreceive a VKA or ASA. You'll find equivalent findings concerning thesuboptimal use of VKAs in those at high risk of stroke in theout-of-hospital setting.22Antiplatelet therapyAcetylsalicylic acid has been extensively utilized as an agent for strokeprophylaxis in patients with AF. Until recently, guidelines recommendedASA therapy only in patients with non-valvular AFwho are regarded as at low risk of stroke, or in whom VKAtherapy is contraindicated.
2,5 Even so, the ESC 2010 guidelinesand the ACC Foundation/AHA/Heart Rhythm Societyfocussed update towards the ACC/AHA/ESC 2006 guidelinesinclude a role for clopidogrel use in conjunction with ASA,suggesting that this dual-antiplatelet combination (-)-MK 801 may be consideredfor stroke prevention in patients for whom oral anticoagulationtherapy may be unsuitable.10,23A number of studies have evaluated the efficacy of antiplateletagents, principally ASA, in lowering thromboembolism in patientswith AF. In their meta-analysis, Hart et al.17 reported a 19%reduction within the RR of stroke in patientswith AF treated with ASA compared with placebo or no treatment.Even so, this reduction in risk was not statistically considerable.
Furthermore, the dose of ASA varied extensively from 50 to1300 mg per day within the studies included within the meta-analysiswith a lot of the advantageous effects of ASA driven from theStroke Prevention in Atrial FibrillationI study, which utilizeda 325 mg dose.10,24 In contrast, the Japan Atrial FibrillationStroke BI-1356 Trial compared an ASA dose of 150–200 mg per daywith no treatment in 871 patients with AF.25 This trial wasstopped early because of a non-significant increase within the risk ofmajor bleeding of 1.6% with ASA, compared with 0.4% in theno-treatment group. Also, the greater number of main endpointeventsin the ASA armcompared with no-treatmentgroupmeant that treatment with ASA was unlikelyto be superior to no treatment.A comparison of antiplateletswith VKA therapy in themeta-analysis by Hart et al. revealed that adjusted-dose warfarinreduced the RR of all stroke by 37%comparedwith antiplatelet therapy.
17 The modest effect of antiplatelet agents on strokerisk may be a lot more because of the inhibition of platelet thrombi in thecarotid and cerebral arteries than the inhibition HSP of cardiogenicthrombi that happen in AF.26 Even so, it really is likely that the lowerbleeding risk with antiplatelet agents compared with that ofVKAsremains their keyattraction.Are combination therapies a viablealternative to vitamin K antagonistor antiplatelet monotherapyin atrial fibrillation?Dual-antiplatelet therapyIn earlier years, the relative efficacy and safety profiles of dualantiplatelettherapyhave been assessed inpatients with AF. Within the Atrial fibrillation ClopidogrelTrial with Irbesartan for prevention of Vascular EventsW study, patients with electrocardiogram-confirmed AF and atleast 1 risk factor for stroke were randomized to receiveclopidogrel with ASA or VKA therapy.
27Clopidogrel plus ASA therapy was connected with significantlymore significant vascular eventsthan VKA therapy. Rates of majorbleeding were equivalent amongst the two groups, but there weresignificantly a lot more instances of minor bleeding within the clopidogrel plusASA group. The study was stopped BI-1356 early owing tothe clear superiority of VKA therapy.Acetylsalicylic acid is prescribed in patients with AF who cannottolerate VKAs.28 The ACTIVE A trial compared theefficacy and safety of clopidogrel plus ASA vs. placebo plus ASAin patients with AF who were at elevated risk of stroke, butwho were regarded as unsuitable for VKA therapy.28 Inthe clopidogrel plus ASA group, there were considerably fewermajor vascular events compared using the placebo plus ASAgroup.
This effect on the main endpointwas mainly (-)-MK 801 because of the decreased incidence of stroke. Even so,significant bleeding occurred a lot more often in patients taking clopidogrelthan those receiving placebo, using the mostcommon web site of bleeding being the gastrointestinal tract. Clopidogrelplus ASA elevated the risk of significant extracranial bleeding by51% and also the risk of significant intracranial bleeding by 87%. There wasno considerable difference in net clinical benefitbetween the two groups.Antiplatelet plus vitamin K antagonisttherapyStudies combining VKAs with antiplatelet BI-1356 therapy in patients withAF have also been performed. Their major aim was to assesswhether combination therapy enabled the intensity of anticoagulationto be decreased, lessening the likelihood of excessive bleedingand the will need for typical monitoring, while preserving protectiveefficacy.The SPAF III trial compared ASA and fixed-dose warfarinwith adjusted-dose warfarin alonein patients with non-valvu