Clinical therapeutics
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Clinical therapeutics · Aug 2013
ReviewNew antiplatelet agents and the role of platelet function testing in acute coronary syndromes.
Dual antiplatelet therapy is a guideline mandated for patients with acute coronary syndromes (ACS). Despite its use, thrombotic events continue to occur both early and late. Platelet function testing has been used to define the in vitro effects of new antiplatelet agents, and it has been suggested that it be used to choose therapy. The role of platelet function testing, particularly with newer antiplatelet agents, remains unclear. ⋯ Recent clinical trials have indicated that newer antiplatelet agents have advantages over clopidogrel in the treatment of ACS. Platelet function testing gives us a guide to the timing, efficacy, and variability of therapy and can correlate with poor patient outcomes; however, the use of antiplatelet function testing to tailor therapy does not seem appropriate.
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Clinical therapeutics · Aug 2013
Comparative StudyA cost-effectiveness analysis of parecoxib in the management of postoperative pain in the Greek health care setting.
Postoperative pain management represents a significant factor of morbidity and reduced quality of life for patients, as well as a situation that substantially increases perioperative costs. Available analgesia treatments improve patient outcomes and reduce resource use associated with pain management, although with varying costs and adverse effects. ⋯ Parecoxib may be a useful addition to opioid treatment by improving postoperative analgesic management, reducing opioid-related adverse events, and lowering per-patient treatment costs.
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Clinical therapeutics · Aug 2013
Improving outcomes after acute coronary syndrome with rehabilitation and secondary prevention.
International studies suggest almost half of all major coronary episodes annually occur in survivors of acute coronary syndrome (ACS). ⋯ Health-service redesign involving all stakeholders will be integral to increasing access, uptake, and adherence to lifestyle, control of risk factors, and pharmacologic therapies shown to improve cardiovascular outcomes.
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Clinical therapeutics · Aug 2013
ReviewManagement of acute coronary syndromes in patients with diabetes: implications of the FREEDOM trial.
Diabetes mellitus (DM) is a powerful independent risk factor for multivessel, diffuse coronary artery disease (CAD). The optimal coronary revascularization strategy in DM is not clearly defined, but past trials have suggested an advantage for coronary artery bypass grafting (CABG). Recently, the Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) trial found patients randomized to CABG had lower rates of death and myocardial infarction (MI) compared with those randomized to percutaneous coronary intervention (PCI). ⋯ The optimal revascularization strategy in patients with acute coronary syndrome, diabetes, and multivessel disease, in particular those with ST elevation, is unclear, and not guided by level A (or B) evidence. Currently CABG is favored over PCI, and an individually tailored, collaborative approach, guided by a multidisciplinary heart team, should be employed.
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Clinical therapeutics · Aug 2013
Randomized Controlled Trial Multicenter Study Comparative StudyA randomized, double-blind study of fenofibric acid plus rosuvastatin compared with rosuvastatin alone in stage 3 chronic kidney disease.
Patients with chronic kidney disease (CKD) often have mixed dyslipidemia and high cardiovascular disease risk. Although statins reduce LDL-C, adding a fibrate may further improve lipid parameters. ⋯ The data suggest that, after 16 weeks of therapy, FA + R has an acceptable safety profile and improved TG and HDL-C efficacy versus R. FA + R combination therapy may thus further improve lipid parameters in patients with stage 3 CKD and mixed dyslipidemia. ClinicalTrials.gov identifier: NCT00680017.