Publications
282 results found
Farag M, Srinivasan M, Gorog DA, 2016, IMPACT OF OPIATE ANALGESIA ON PLATELET REACTIVITY IN PATIENTS PRESENTING FOR PRIMARY PERCUTANEOUS CORONARY INTERVENTION, Annual Conference of the British-Cardiovascular-Society (BCS) on Prediction and Prevention, Publisher: BMJ PUBLISHING GROUP, Pages: A19-A19, ISSN: 1355-6037
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- Citations: 1
Farag M, Srinivasan M, Wellsted D, et al., 2016, MEASUREMENT OF ENDOGENOUS THROMBOLYSIS REFLECTS SPONTANEOUS REPERFUSION AND FUTURE THROMBOSIS RISK IN PPCI, BCIS Advanced Cardiovascular Intervention (ACI) Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A4-15, ISSN: 1355-6037
Farag M, Niespialowska-Steuden M, Okafor O, et al., 2016, Relative effects of different non-vitamin K antagonist oral anticoagulants on global thrombotic status in atrial fibrillation, Platelets, Vol: 27, Pages: 687-693, ISSN: 0953-7104
Non-vitamin K antagonist oral anticoagulants (NOACs) reduce the risk of thromboembolism in patients with atrial fibrillation (AF). There has been no head-to-head comparison of the effect of these agents on ex vivo thrombotic and thrombolytic status. Enhanced platelet reactivity and impaired endogenous thrombolysis are risk factors for recurrent thrombotic events. We aimed to assess the comparative effect of NOACs and warfarin using an ex vivo test of thrombosis and thrombolysis. Eighty patients with newly diagnosed non-valvular AF were tested before, and after being established on apixaban (n = 20), dabigatran (n = 20), rivaroxaban (n = 20), or warfarin (n = 20). Thrombotic status was assessed with the automated, point-of-care Global Thrombosis Test (GTT) that assesses both platelet reactivity and endogenous thrombolysis from native blood. The time taken to form an occlusive thrombus (occlusion time, OT) and the time required to restore flow through endogenous thrombolysis (lysis time, LT) were measured. All anticoagulants caused OT prolongation compared to baseline (apixaban 403 ± 102s vs. 496 ± 125s, p = 0.006; dabigatran 471 ± 106s vs. 656 ± 165s, p < 0.00001; rivaroxaban 381 ± 119s vs. 579 ± 158, p < 0.00001; warfarin 420 ± 145s vs. 604 ± 124s, p < 0.00001). Apixaban reduced LT from baseline (1895[1702–2167]s vs. 1435[347–1990]s; p = 0.006). A trend for LT reduction was seen with other NOACs (dabigatran 1594[1226–2069]s vs. 1539[561–2316]s, p = 0.499; rivaroxaban 2085[1366–2428]s vs. 1885[724–2420]s, p = 0.295) but not with warfarin (1490[1206–1960]s vs. 1776[1545–2334], p = 0.601). Our results suggest that NOACs and warfarin have a similar favorable effect on reducing platelet reactivity. All NOACs exhibited a trend toward enhancing endogenous thrombolytic status, although this was significant only for apixaban. This raises the possibility of using N
Farag M, Costopoulos C, Gorog DA, et al., 2016, Treatment of calcified coronary artery lesions, EXPERT REVIEW OF CARDIOVASCULAR THERAPY, Vol: 14, Pages: 683-690, ISSN: 1477-9072
Otsui K, Gorog DA, Yamamoto J, et al., 2015, Global Thrombosis Test - a possible monitoring system for the effects and safety of dabigatran, Thrombosis Journal, Vol: 13, ISSN: 1477-9560
BACKGROUND: Dabigatran is an alternative to warfarin (WF) for the thromboprophylaxis of stroke in patients with non-valvular atrial fibrillation (NVAF). The advantage of dabigatran over WF is that monitoring is not required; however, a method to monitor the effect and the safety of dabigatran is not currently available. The Global Thrombosis Test (GTT) is a novel method to assess both clot formation and lysis activities under physiological conditions. OBJECTIVE: The aim of this study was to evaluate whether treatment with dabigatran might affect shear-induced thrombi (occlusion time [OT], sec) by the GTT, and to investigate the possibility that the GTT could be useful as a monitoring system for dabigatran. PATIENTS/METHODS: The study population consisted of 50 volunteers and 43 NVAF patients on WF therapy, who were subsequently switched to dabigatran. Using the GTT, the thrombotic status was assessed one day before and 1 month after switching anticoagulation from WF to dabigatran. RESULTS: The OT was 524.9 ± 17.0 sec in volunteers whereas that of NVAF patients on WF therapy was 581.7 ± 26.3 sec. The switch from WF to dabigatran significantly prolonged OT (784.5 ± 19.3 sec). One patient on WF therapy and 12 patients on dabigatran therapy were shown to have OT > 900 sec. CONCLUSION: The GTT could be used to assess the risk of dabigatran-related bleeding complications.
Farag M, Gorog DA, Prasad A, et al., 2015, Bivalirudin versus unfractionated heparin: a meta-analysis of patients receiving percutaneous coronary intervention for acute coronary syndromes, Open Heart, Vol: 2, ISSN: 2053-3624
OBJECTIVE: Acute coronary syndrome (ACS) encompasses ST segment elevation myocardial infarction (STEMI), with generally high thrombus burden and non-ST segment elevation ACS (NSTE-ACS), with lower thrombus burden. In the setting of percutaneous coronary intervention (PCI) for ACS, bivalirudin appears superior to unfractionated heparin (UFH), driven by reduced major bleeding. Recent trials suggest that the benefit of bivalirudin may be reduced with use of transradial access and evolution in antiplatelet therapy. Moreover, a differential role of bivalirudin in ACS cohorts is unknown. METHODS: A meta-analysis of randomised trials comparing bivalirudin and UFH in patients with ACS receiving PCI, with separate analyses in STEMI and NSTE-ACS groups. Overall estimates of treatment effect were calculated with random-effects model. RESULTS: In 5 trials of STEMI (10 358 patients), bivalirudin increased the risk of acute stent thrombosis (ST) (OR 3.62; CI 1.95 to 6.74; p<0.0001) compared with UFH. Bivalirudin reduced the risk of major bleeding only when compared with UFH plus planned glycoprotein IIb/IIIa inhibitors (GPI) (OR 0.49; CI 0.36 to 0.67; p<0.00001). In 14 NSTE-ACS trials (25 238 patients), there was no difference between bivalirudin and UFH in death, myocardial infarction or ST. However, bivalirudin reduced the risk of major bleeding compared with UFH plus planned GPI (OR 0.52; CI 0.43 to 0.62; p<0.00001), or UFH plus provisional GPI (OR 0.68; CI 0.46 to 1.01; p=0.05). The reduction in major bleeding with bivalirudin was not related to vascular access site. CONCLUSIONS: Bivalirudin increases the risk of acute ST in STEMI, but may confer an advantage over UFH in NSTE-ACS while undergoing PCI, reducing major bleeding without an increase in ST.
Jeong Y-H, Gorog DA, Kim JS, 2015, Varying Responses to Antithrombotic Treatment by Race/Ethnicity, JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol: 314, Pages: 624-625, ISSN: 0098-7484
Farag M, Okafor O, Niespialowska-Steuden M, et al., 2015, Patients who revert to atrial fibrillation after cardioversion demonstrate impaired thrombotic status, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 392-392, ISSN: 0195-668X
Farag M, Patel H, Gorog DA, 2015, Adjunctive therapies to reduce thrombotic events in patients with a history of myocardial infarction: role of vorapaxar, Drug Design Development and Therapy, Vol: 9, Pages: 3801-3809, ISSN: 1177-8881
Acute myocardial infarction (AMI) is generally attributed to coronary atherothrombotic disease. Platelet activation is essential for thrombus formation and is thus an important target for pharmacological intervention to prevent and treat AMI. Despite contemporary treatment with dual antiplatelet therapy, including acetylsalicylic acid and adenosine diphosphate receptor antagonists, patients with prior AMI remain at increased risk of future thrombotic events. This has stimulated the search for more potent antithrombotic agents. Among these is the oral protease-activated receptor-1 antagonist vorapaxar, which represents a new oral antiplatelet agent to reduce thrombotic risk in patients with atherothrombotic disease. The TRACER and the TRA 2°P-TIMI 50 trials concluded that vorapaxar in addition to standard therapy reduced ischemic adverse cardiac events. A remarkable benefit was observed in patients with stable atherosclerotic disease, particularly those with a previous history of AMI. Although favorable effects were seen in reduction of adverse cardiac events, this was associated with excess major and intracranial bleeding, particularly in patients at high risk of bleeding and those with a history of stroke or transient ischemic attack. Currently, the lack of a reliable individualized risk stratification tool to assess patients for thrombotic and bleeding tendencies in order to identify those who might gain most net clinical benefit has led to limited use of vorapaxar in clinical practice. Vorapaxar may find a niche as an adjunct to standard care in patients at high risk of thrombotic events and who are at low risk of bleeding.
Farag M, Okafor O, Niespialowska-Steuden M, et al., 2015, EFFECT OF ELECTRICAL CARDIOVERSION ON THROMBOTIC STATUS, British-Cardiac-Society (BCS) Annual Conference on Hearts and Genes, Publisher: BMJ PUBLISHING GROUP, Pages: A32-A32, ISSN: 1355-6037
Niespialolwska-Steuden M, Markides V, Okafor O, et al., 2015, IMPROVEMENT IN ENDOGENOUS THROMBOLYTIC STATUS FOLLOWING SUCCESSFUL ABLATION OF ATRIAL FIBRILLATION, British-Cardiac-Society (BCS) Annual Conference on Hearts and Genes, Publisher: BMJ PUBLISHING GROUP, Pages: A30-A30, ISSN: 1355-6037
Farag M, Kirby M, Ibrahim A, et al., 2015, TESTOSTERONE THERAPY IN MEN WITH CORONARY ARTERY DISEASE, British-Cardiac-Society (BCS) Annual Conference on Hearts and Genes, Publisher: BMJ PUBLISHING GROUP, Pages: A91-A91, ISSN: 1355-6037
Gorog DA, Jeong Y-H, 2015, Platelet function tests: why they fail to guide personalized antithrombotic medication, Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease, Vol: 4, ISSN: 2047-9980
Okafor ON, Gorog DA, 2015, Endogenous Fibrinolysis, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 65, Pages: 1683-1699, ISSN: 0735-1097
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- Citations: 75
Niespialowska-Steuden M, Markides V, Okafor O, et al., 2015, ATRIAL FIBRILLATION ABLATION IMPROVES GLOBAL THROMBOTIC STATUS THROUGH ENDOGENOUS THROMBOLYSIS, AS EARLY AS 3 MONTHS POST ABLATION, Scientific Session of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: A421-A421, ISSN: 0735-1097
Farag M, Gorog DA, 2015, Rivaroxaban in atrial fibrillation cardioversion: insights from the X-VeRT trial, FUTURE CARDIOLOGY, Vol: 11, Pages: 147-151, ISSN: 1479-6678
Gorog DA, Otsui K, Inoue N, 2015, Usefulness of Platelet Function Tests to Predict Bleeding With Antithrombotic Medications, CARDIOLOGY IN REVIEW, Vol: 23, Pages: 323-327, ISSN: 1061-5377
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- Citations: 5
Rosser G, Tricoci P, Morrow D, et al., 2014, PAR-1 antagonist vorapaxar favorably improves global thrombotic status in patients with coronary disease, JOURNAL OF THROMBOSIS AND THROMBOLYSIS, Vol: 38, Pages: 423-429, ISSN: 0929-5305
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- Citations: 16
O'Donoghue ML, Braunwald E, White HD, et al., 2014, Effect of Darapladib on Major Coronary Events After an Acute Coronary Syndrome The SOLID-TIMI 52 Randomized Clinical Trial, JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol: 312, Pages: 1006-1015, ISSN: 0098-7484
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- Citations: 327
Niespialowska-Steuden M, Okafor O, Collins P, et al., 2014, DIFFERENTIAL EFFECTS OF NOAC AND VKA ON <i>IN VITRO</i> TEST OF GLOBAL THROMBOTIC STATUS, Annual Conference of the British-Cardiovascular-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A8-A8, ISSN: 1355-6037
Niespialowska-Steuden M, Christopoulos C, Okafor O, et al., 2014, COMPARISON OF GLOBAL THROMBOTIC STATUS IN AF AND CORONARY DISEASE, HEART, Vol: 100, Pages: A15-A15, ISSN: 1355-6037
Yamamoto J, Inoue N, Otsui K, et al., 2014, Global Thrombosis Test (GTT) can detect major determinants of haemostasis including platelet reactivity, endogenous fibrinolytic and thrombin generating potential, THROMBOSIS RESEARCH, Vol: 133, Pages: 919-926, ISSN: 0049-3848
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- Citations: 28
Niespialowska-Steuden M, Christopoulos C, Okafor O, et al., 2014, CHARACTERISATION OF DIFFERING IN VITRO THROMBOTIC PROFILES IN AF AND CORONARY DISEASE: ROLE OF ENDOGENOUS THROMBOLYSIS, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 63, Pages: A467-A467, ISSN: 0735-1097
Niespialowska-Steuden M, Okafor O, Collins P, et al., 2014, NOAC BUT NOT VKA FAVORABLY AFFECT ENDOGENOUS THROMBOLYTIC STATUS: A NOVEL MECHANISM OF ACTION, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 63, Pages: A323-A323, ISSN: 0735-1097
Gorog DA, 2014, IMPAIRED ENDOGENOUS THROMBOLYSIS- A NOVEL, POINT-OF-CARE BIOMARKER PREDICTIVE OF ADVERSE CARDIOVASCULAR EVENTS, CARDIOLOGY, Vol: 128, Pages: 139-139, ISSN: 0008-6312
Niespialowska-Steuden M, Collins P, Costopoulos C, et al., 2014, NOAC in acute coronary syndrome and AF?, Cardiovasc Hematol Disord Drug Targets, Vol: 14, Pages: 154-164
Cardiovascular disease remains a major cause of morbidity and mortality in developed countries. New treatments, in the form of novel oral anticoagulants (NOAC) that reduce thrombotic risk are now available for patients with atrial fibrillation (AF) or acute coronary syndrome (ACS). Warfarin has been the cornerstone of thromboprophylaxis in patients with AF, but treatment is cumbersome, inconvenient and often unreliable, with fluctuating time in therapeutic range. Thrombotic events also continue to occur in a significant number of ACS patients despite antiplatelet therapy. Thus there is an unfilled need to reduce thrombotic events in ACS and AF patients. NOAC comprise direct factor Xa inhibitors (apixaban, rivaroxaban, darexaban, edoxaban), direct thrombin inhibitors (dabigatran) and PAR-1 antagonists (vorapaxar, atopaxar). In this review, we compare and contrast NOACs and review their individual and specific clinical trial database in ACS and AF. In the setting of ACS, the role of NOAC is unclear, as any reduction in ischemic events appears to be offset by hemorrhagic risk. However, NOAC have a definite place in the treatment of patients with non-valvular AF, where they are at least as effective, if not superior to warfarin.
Costopoulos C, Niespialowska-Steuden M, Kukreja N, et al., 2013, Novel oral anticoagulants in acute coronary syndrome, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 167, Pages: 2449-2455, ISSN: 0167-5273
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- Citations: 29
Gorog DA, Fuster V, 2013, Platelet Function Tests in Clinical Cardiology Unfulfilled Expectations, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 61, Pages: 2115-2129, ISSN: 0735-1097
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- Citations: 63
Gorog DA, Christopoulos C, Niespialowska-Steuden MN, et al., 2013, PAR-1 ANTAGONIST VORAPAXAR IMPROVES GLOBAL THROMBOTIC STATUS IN PATIENTS WITH CORONARY DISEASE, 62nd Annual Scientific Session of the American-College-of-Cardiology, Publisher: ELSEVIER SCIENCE INC, Pages: E223-E223, ISSN: 0735-1097
Niespialowska-Steuden M, Markides V, Jones D, et al., 2013, CATHETER ABLATION FOR ATRIAL ARRHYTHMIAS RAPIDLY IMPROVES THROMBOTIC PROFILE OVER AND ABOVE THERAPEUTIC ANTICOAGULATION, 62nd Annual Scientific Session of the American-College-of-Cardiology, Publisher: ELSEVIER SCIENCE INC, Pages: E275-E275, ISSN: 0735-1097
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