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Posts Tagged ‘esc guidelines’

Why is Aspirin, everyone’s nemesis ?

Posted in Uncategorized, tagged , , , , , on February 1, 2024|

Here is a current review on a topic, which needs some Introspection

For a kid, A stands for apple in kindergarten, while in the school of cardiac pharmacology, A would sound as Aspirin. Such is the importance of this drug, known for its obedient, predictable efficiency in the entire spectrum of CAD right from primary prevention of CAD to emergent primary angioplasty in Cath lab. Most of us will also agree, It is a work horse drug, not only for the cardiologists , but has been an anchor drug in as many critical general medical therapeutics, wherever platelets are to be passivated.

We are well aware of molecular basis of this drugs action. Aspirin impacts most points in the core axis of platelet adhesion , activation and aggregation either directly or indirectly .(Though, its just a COX 1 blocker) Its efficiency is backed by countless papers with authenticated evidence.

Final message

“Now, we, realize Aspirin is being targeted and facing potential elimination “

Why is this happening ?

Aspirin acts by just blocking thromboxane mediated platelet activation , it doesn’t antagonize adenosine triggered activation, hence it is useless is the argument. Some how, our thought faculty is intruded , and unable to realize, the same question can be played in reverse .

P2-Y12 blockers in whatever form & fashion ,helplessly watch thromboxane A2 promoting platelets activation , isn’t ? Please understand, many cases of Clopidogrel and Ticagrelor resistance is apparently related to lack of assistance from the Aspirin .(Genetic P450 heterogenicity story doesn’t explain this fully )

The other concern is Aspirin increases the bleeding risk. It is a perfect irony , this argument is exactly opposite the one discussed above, Implying Aspirin could be a more powerful anti-platelet agent.

It is a duty of every one of us, to find the true reasons for such a bias against Aspirin. However strong the evidence base, (that is being created) It is very difficult to believe , Aspirin is shown the exit door for academic reasons.

Post test

If you want to convert Dual-APT to Mono-APT , which will you jettison ?

A.Aspirin

B.Clopidogrel

C.Ticagrelor

D.Whatever the guideline say.

E.Will leave it to the patient to decide.

Reference

1.Piera Capranzano, David Moliterno, Davide Capodanno, Aspirin-free antiplatelet strategies after percutaneous coronary interventions, European Heart Journal, 2024;, ehad876, https://doi.org/10.1093/eurheartj/ehad876

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The ultimate guidelines for managing adult congenital heart disease from European society of cardiology !

Posted in Uncategorized, tagged , , , , on September 18, 2010| Leave a Comment »

The classical statistics says  Congenital heart disease occurs .8/1000 in general population. Survival into adult hood is  an entirely different story  .In the last half a century  , cardiac surgeons ably  assisted by anestheteists (Most dedicated ,Hats off !) , interventional cardiologists (With some conflicts !)    have lifted up the survival curve of all sort of  congenital  heart disease.

We have now complete  cure for  many   of the  dreaded diseases of the past .Currently ,most cases of TOF, VSD, ASD , Co-arctation of aorta,  bulk of the TGVs , DORVs are correctible.Only patients with severe forms of hypoplastiv LV, pulmonary atresias and complex outflow defects are facing death in infancy.

However ,  these patients often require prolonged follow up and may require  staged surgeries,  especially who undergo univentricualr  repair for complex cyanotic diseases .Some require   fine tuning of the  anatomical conduits  etc as dictated by the growth of child. Few may develop complications in adult hood .

 This may be due to

  •   Added hemodynamic stress 
  •   Infection of the  biological or synthetic material used .
  •   Few will show progression of the native disease .

 The timing of release of this guideline could not be more appropriate . In this hi -tech pediatric cardiology  era , we are  talking about cardiac transplantation for complex CHD , where surgery is not possible or has unacceptable mortality .

ESC  has updated the version in 2010.  Let us enjoy this 43 page treasure , gifted to cardiac physicians, surgeons and the fellows !

Link placed  here  with the  due courtesy  of  ESC

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