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Clinical Trials of Ticlopidine in Patients with Coronary Artery Disease

  • Francesco Balsano
  • Francesco Violi

Abstract

Acute coronary syndromes, including myocardial infarction, unstable angina, and early complications occurring after aortocoronary bypass or angioplasty, are well recognized conditions in which in situ activation of platelets and the coagulation cascade play a pivotal role. Therefore, anticoagulant or antiplatelet drugs have been employed to reduce vascular thrombosis and minimize clinical complications secondary to vascular occlusion. In regard to antiplatelet drugs, many studies have been performed with aspirin, an inhibitor of the cyclooxygenase enzyme that prevents formation of thromboxane TXA2, a potent aggregating and vasoconstrictor agent.

Keywords

Unstable Angina Vein Graft Antiplatelet Drug Nonfatal Myocardial Infarction Vascular Death 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Antiplatelet Trialists’ Collaboration. Secondary prevention of vascular disease by prolonged antiplatelet treatment. Br Med J 1988; 296: 320–331.CrossRefGoogle Scholar
  2. 2.
    Maseri A. Pathogenic classification of unstable angina as a guideline to individual patient management and prognosis. Am J Med 1986; 80: 48–55.PubMedCrossRefGoogle Scholar
  3. 3.
    Falk E. Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death. Circulation 1985; 71: 699–708.PubMedCrossRefGoogle Scholar
  4. 4.
    Duncan B, Fulton M, Morrison SL, Lutz W, Donald KW, Kerr F, Kirby BJ, Julian DG, Oliver FM. Prognosis of new and worsening angina pectoris. Br Med J 1976; 1: 981–985.PubMedCrossRefGoogle Scholar
  5. 5.
    Braunwald E. Unstable angina: a classification. Circulation 1989; 80: 410–414.PubMedCrossRefGoogle Scholar
  6. 6.
    Neill WA, Ritzmann LW, Selden R. The pathophysiologic basis of acute coronary insufficiency: observations favouring the hypothesis of intermittent reversible coronary obstruction. Am Heart J 1977; 94: 439–445.PubMedCrossRefGoogle Scholar
  7. 7.
    Moise A, Theroux P, Taeymans Y, Descoings B, Lesperance Y, Waters DD, Pelletier GB, Bourasse MG. Unstable angina and progression of coronary atherosclerosis. NEngl JMed 1983; 309: 685–689.CrossRefGoogle Scholar
  8. 8.
    Ambrose JA, Winters SL, Arora RR, Eng A, Ricco A, Gorlin R, Fuster V. Angiographic evaluation of coronary artery morphology in unstable angina. JACC 1986; 7: 472–478.PubMedGoogle Scholar
  9. 9.
    Fuster V, Badimon L, Cohen M, Ambrose JA, Badimon JJ, Chesebro J. Insights into the pathogenesis of acute ischemic syndromes. Circulation 1988; 77: 1213–1220.PubMedCrossRefGoogle Scholar
  10. 10.
    Falk E. Thrombosis in unstable angina: pathologic aspects. In Metha JL, Conti CR (eds) Thrombosis and Platelets in Myocardial Ischemia, FA Davis Company, Philadelphia, 1987, pp 137–149.Google Scholar
  11. 11.
    Sherman CT, Litvack F, Grundfest W, Lee M, Hickey A, Chaux A, Kass R, Blanche C, Matloff J, Morgenstern L, Ganz W, Swan HJC, Forrester J. Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med 1986; 315: 913–919.PubMedCrossRefGoogle Scholar
  12. 12.
    Davies MI, Thomas AC, Knapman PA, Hangertuer JR. Intramyocardial platelet aggregation in patients with unstable angina suffering sudden ischemic cardiac death. Circulation 1986; 73: 418–427.PubMedCrossRefGoogle Scholar
  13. 13.
    Fitzgerald DJ, Roy L, Catella F, Fitzgerald G. Platelet activation in unstable coronary disease. N Engl J Med 1986; 315: 983–989.PubMedCrossRefGoogle Scholar
  14. 14.
    Vejar M, Fragasso G, Hackett D, et al. Dissociation of platelet activation and spontaneous myocardial ischemia in unstable angina. Thromb Haemost 1990; 63: 163–168.PubMedGoogle Scholar
  15. 15.
    Lewis HD, Davis JW, Archibald DG, et al. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. N Engl J Med 1983; 309: 396–403.PubMedCrossRefGoogle Scholar
  16. 16.
    Cairns JA, Gent M, Singer J, et al. Aspirin, sulphinpyrazone, or both in unstable angina. N Engl J Med 1985; 313: 1396–1475.CrossRefGoogle Scholar
  17. 17.
    Harker LA, Fuster V. Pharmacology of platelet inhibitors. JACC 1986; 8: 21b - 32b.PubMedGoogle Scholar
  18. 18.
    Maffrand JP, Bernat A, Delebassée D, Defreyn G, Cazenave JP, Gordon JL. ADP plays a key role in thrombogenesis in rats. Thromb Haemost 1988; 59: 225–230.PubMedGoogle Scholar
  19. 19.
    di Minno G, Cerbone AM, Mattioli PL, Turco S, Iovine C, Mancini M. Functionally thromboasthenic state in normal platelets following the administration of ticlopidine. J Clin Invest 1985; 75: 328–338.PubMedCrossRefGoogle Scholar
  20. 20.
    Panak EA, Maffrand JP, Picard-Fraire C, Vallée E, Blanchard JF, Roncucci R. Ticlopidine: a promise for the prevention and treatment of thrombosis and its complications. Haemostasis 1983; 13 (suppl 1): 1–54.PubMedGoogle Scholar
  21. 21.
    Theroux P, Ouimet H, McCans J, et al. Aspirin, heparin, or both to treat acute unstable angina. NEnglJMed 1988; 319: 1105–1112.CrossRefGoogle Scholar
  22. 22.
    RISC Group. Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. Lancet 1990; 336: 827–830.CrossRefGoogle Scholar
  23. 23.
    Balsano F, Rizzon P, Violi F, et al. Study of ticlopidine in unstable angina. Circulation 1990; 82: 17–26.PubMedCrossRefGoogle Scholar
  24. 24.
    Chesebro JH, Fuster V. Role of platelet and platelet inhibitors in aortocoronary artery vein-graft occlusion. Circulation 1986; 73: 227–232.PubMedCrossRefGoogle Scholar
  25. 25.
    Campeen L, Lesperance Y, Grondin CM, Bourasse MG. Angiographic evaluation of post-operative changes in saphenous vein aorto-coronary by-pass graft and coronary arteries. Prog Cardiol 1977; 6: 185–211.Google Scholar
  26. 26.
    Josa M, Lia JT, Bianco RL, Kaye M. Reduction of thrombosis in canine coronary bypass vein grafts with dipyridamole and aspirin. Am J Cardiol 1981; 47: 1248–54.PubMedCrossRefGoogle Scholar
  27. 27.
    Unni KK, Kottke BA, Titus JL, et al. Pathologic changes in aortocoronary saphenous vein grafts. Am J Cardiol 1974; 34: 526–532.PubMedCrossRefGoogle Scholar
  28. 28.
    Chesebro JH, Lem JY, Fuster V. The pathogenesis and prevention of aortocoronary vein bypass occlusion and restenosis after arterial angioplasty: role of vascular injury and platelet thrombus deposition. JACC 1986; 8: 57b - 66b.PubMedGoogle Scholar
  29. 29.
    Walter P, Geronlanos S, Rothlin M, et al. Dierasterelek tronenoposchen Oberflichenveran-derungen der Gefassunflache gewobener Dacrongefassprothesen uach Varabreichung von Ticlopidine. Folia Angiol 1987; 29: 20–32.Google Scholar
  30. 30.
    Chevigné M, David JL, Rigo P, Limet R.Effect of ticlopidine on saphenous vein bypass patency rates: a double-blind study. Ann Thorac Surg 1984; 37: 371–378.PubMedCrossRefGoogle Scholar
  31. 31.
    Rothlin ME, Pflunger N, Speiser K, et al. Platelet inhibitors versus anticoagulants for prevention of aortocoronary bypass graft occlusion. Eur Heart J 1985; 6: 168–175.PubMedGoogle Scholar
  32. 32.
    Limet R, David IL, Megotteaux P, Larock MP, Rigo P. Prevention of aorto-coronary bypass graft occlusion. Beneficial effect of ticlopidine on early and late patency rates of venous coronary bypass grafts: a double-blind study. Ann Thorac Surg 1987; 94: 773–783.Google Scholar
  33. 33.
    Heras M, Chesebro JH, Penny WJ, et al. Importance of adequate heparin dosage in arterial angioplasty in a porcine model. Circulation 1988; 78: 654–660.PubMedCrossRefGoogle Scholar
  34. 34.
    Lin MW, Ronbin GS, Spencer BK. Restenosis after coronary angioplasty. Potential biologic determinants and role of intimal hyperplasia. Circulation 1989; 79: 1357–1387.Google Scholar
  35. 35.
    White CW, Chaitman B, Lasser TA, et al. Antiplatelet agents are effective in reducing the immediate complications of PTCA: results from Ticlopidine Multicenter Study. Circulation 1987; 76 (suppl IV): 1591.Google Scholar
  36. 36.
    Bertrand ME, Allain H, Lablanche JM, et al. Results of a randomized trial of ticlopidine versus placebo for prevention of acute closure and restenosis after coronary angioplasty (PTCA). The TACT study. XIIth Congress of the European Society of Cardiology. Abstract supplement P2022, 1990.Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1993

Authors and Affiliations

  • Francesco Balsano
  • Francesco Violi

There are no affiliations available

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