Dual antiplatelet therapy (DAPT) remains the gold standard in patients who underwent percutaneous coronary intervention (PCI). This meta-analysis aims to evaluate the clinical safety of 1-month DAPT followed by aspirin or a P2Y12 receptor inhibitor after PCI with drug-eluting stents (DES). We searched PubMed, MEDLINE, Embase, Scopus, Google Scholar, Cochrane Central Registry, and ClinicalTrials.gov databases and identified 5 randomized controlled trials with 29,831 patients who underwent PCI with DES and compared 1-month versus >1-month DAPT. The primary end point was major bleeding, and the co-primary end point was stent thrombosis. The secondary end point included all-cause mortality, cardiovascular death, myocardial infarction, stroke, and major adverse cardiovascular or cerebrovascular events. Compared with >1-month DAPT, the 1-month DAPT was associated with a lower rate of major bleeding (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.45 to 0.97, p = 0.03, I2 = 71%), whereas stent thrombosis had a similar rate in both study groups (OR 1.08, 95% CI 0.81 to 1.44, p = 0.60, I2 = 0.0%). The study groups had similar risks for all-cause mortality (OR 0.89, 95% CI 0.77 to 1.04, p = 0.14, I2 = 0.0%), cardiovascular death (OR 0.84, 95% CI 0.59 to 1.19, p = 0.32, I2 = 0.0%), myocardial infarction (OR 1.04, 95% CI 0.89 to 1.21, p = 0.62, I2 = 0.0%), and stroke (OR 0.82, 95% CI 0.64 to 1.05, p = 0.11, I2 = 6%). The risk of major adverse cardiovascular or cerebrovascular events was lower (OR 0.86, 95% CI 0.76 to 0.97, p = 0.02, I2 = 25%) in the 1-month DAPT compared with >1-month DAPT. In conclusion, in patients who underwent PCI with DES, 1-month DAPT followed by aspirin or a P2Y12 receptor inhibitor reduced major bleeding with no risk of increased thrombotic risk compared with longer-term DAPT.
- Klíčová slova
- acute coronary syndrome, dual antiplatelet therapy, percutaneous coronary intervention, stable coronary artery disease,
- MeSH
- Aspirin aplikace a dávkování škodlivé účinky MeSH
- časové faktory MeSH
- duální protidestičková léčba * škodlivé účinky metody MeSH
- inhibitory agregace trombocytů * aplikace a dávkování škodlivé účinky MeSH
- koronární angioplastika * škodlivé účinky MeSH
- koronární trombóza prevence a kontrola epidemiologie MeSH
- krvácení * chemicky indukované epidemiologie MeSH
- lidé MeSH
- randomizované kontrolované studie jako téma MeSH
- stenty uvolňující léky * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- systematický přehled MeSH
- Názvy látek
- Aspirin MeSH
- inhibitory agregace trombocytů * MeSH
OBJECTIVES: The objective of this post hoc analysis was to analyze real-world dual antiplatelet therapy (DAPT) regimens following polymer-free sirolimus-eluting stent (PF-SES) implantations in an unselected patient population. METHODS: Patient-level data from two all-comers observational studies (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled and analyzed in terms of their primary endpoint. During the data verification process, we observed substantial deviations from DAPT guideline recommendations. To illuminate this gap between clinical practice and guideline recommendations, we conducted a post hoc analysis of DAPT regimens and clinical event rates for which we defined the net adverse event rate (NACE) consisting of target lesion revascularization (TLR, primary endpoint of all-comers observational studies) all-cause death, myocardial infarction (MI), stent thrombosis (ST), and bleeding events. A logistic regression was utilized to determine predictors why ticagrelor was used in stable coronary artery disease (CAD) patients instead of the guideline-recommended clopidogrel. RESULTS: For stable CAD, the composite endpoint of clinical, bleeding, and stent thrombosis, i.e., NACE, between the clopidogrel and ticagrelor treatment groups was not different (5.4% vs. 5.1%, p = 0.745). Likewise, in the acute coronary syndrome (ACS) cohort, the NACE rates were not different between both DAPT strategies (9.2% vs. 9.3%, p = 0.927). There were also no differences in the accumulated rates for TLR, myocardial infarction ([MI], mortality, bleeding events, and stent thrombosis in elective and ACS patients. The main predictors for ticagrelor use in stable CAD patients were age < 65 years, smaller vessels, treatment of ostial and calcified lesions, and in-stent restenosis. CONCLUSION: Within the framework of a post hoc analysis based on a real-world, large cohort study, there were no differences in the combined endpoint of major adverse cardiac events (MACE), bleeding and thrombotic events for clopidogrel and ticagrelor in stable CAD or ACS patients. Despite the recommendation for clopidogrel by the European Society of Cardiology (ESC), real-world ticagrelor use was observed in subgroups of stable CAD patients that ought to be explored in future trials.
- Klíčová slova
- Clopidogrel, Dual antiplatelet therapy, Polymer-free, Sirolimus-eluting stent, Ticagrelor,
- MeSH
- časové faktory MeSH
- dodržování směrnic MeSH
- duální protidestičková léčba * škodlivé účinky mortalita MeSH
- hodnocení rizik MeSH
- inhibitory agregace trombocytů aplikace a dávkování škodlivé účinky MeSH
- kardiovaskulární látky aplikace a dávkování škodlivé účinky MeSH
- koronární angioplastika škodlivé účinky přístrojové vybavení mortalita MeSH
- koronární trombóza etiologie prevence a kontrola MeSH
- krvácení chemicky indukované MeSH
- lékařská praxe - způsoby provádění MeSH
- lidé středního věku MeSH
- lidé MeSH
- multicentrické studie jako téma MeSH
- nemoci koronárních tepen diagnostické zobrazování mortalita terapie MeSH
- pozorovací studie jako téma MeSH
- protézy - design MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- sirolimus aplikace a dávkování škodlivé účinky MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- stenty uvolňující léky * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- inhibitory agregace trombocytů MeSH
- kardiovaskulární látky MeSH
- sirolimus MeSH
OBJECTIVES: High platelet reactivity (HPR) was studied in patients presenting with ST-segment elevation myocardial infarction (STEMI) due to stent thrombosis (ST) undergoing immediate percutaneous coronary intervention (PCI). BACKGROUND: HPR on P2Y12 inhibitors (HPR-ADP) is frequently observed in stable patients who have experienced ST. The HPR rates in patients presenting with ST for immediate PCI are unknown. METHODS: Consecutive patients presenting with definite ST were included in a multicenter ST registry. Platelet reactivity was measured before immediate PCI with the VerifyNow P2Y12 or Aspirin assay. RESULTS: Platelet reactivity was measured in 129 ST patients presenting with STEMI undergoing immediate PCI. HPR-ADP was observed in 76% of the patients, and HPR on aspirin (HPR-AA) was observed in 13% of the patients. HPR rates were similar in patients who were on maintenance P2Y12 inhibitor or aspirin since stent placement versus those without these medications. In addition, HPR-ADP was similar in patients loaded with a P2Y12 inhibitor shortly before immediate PCI versus those who were not. In contrast, HPR-AA trended to be lower in patients loaded with aspirin as compared with those not loaded. CONCLUSIONS: Approximately 3 out of 4 ST patients with STEMI undergoing immediate PCI had HPR-ADP, and 13% had HPR-AA. Whether patients were on maintenance antiplatelet therapy while developing ST or loaded with P2Y12 inhibitors shortly before undergoing immediate PCI had no influence on the HPR rates. This raises concerns that the majority of patients with ST have suboptimal platelet inhibition undergoing immediate PCI.
- Klíčová slova
- P2Y(12) receptor antagonists, aspirin, platelet aggregation, platelet function tests, stent thrombosis,
- MeSH
- adenosindifosfát krev MeSH
- biologické markery krev MeSH
- časové faktory MeSH
- infarkt myokardu s elevacemi ST úseků krev diagnostické zobrazování etiologie chirurgie MeSH
- inhibitory agregace trombocytů škodlivé účinky terapeutické užití MeSH
- koronární angioplastika škodlivé účinky přístrojové vybavení MeSH
- koronární trombóza krev diagnostické zobrazování etiologie prevence a kontrola MeSH
- léková rezistence MeSH
- lidé středního věku MeSH
- lidé MeSH
- purinergní receptory P2Y - antagonisté škodlivé účinky terapeutické užití MeSH
- purinergní receptory P2Y12 krev účinky léků MeSH
- recidiva MeSH
- registrace MeSH
- rizikové faktory MeSH
- senioři MeSH
- stenty škodlivé účinky MeSH
- trombocyty účinky léků metabolismus MeSH
- vyšetření funkce trombocytů MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Geografické názvy
- Evropa MeSH
- Názvy látek
- adenosindifosfát MeSH
- biologické markery MeSH
- inhibitory agregace trombocytů MeSH
- P2RY12 protein, human MeSH Prohlížeč
- purinergní receptory P2Y - antagonisté MeSH
- purinergní receptory P2Y12 MeSH
BACKGROUND: Prior Studies have suggested better outcomes in smokers compared with nonsmokers receiving clopidogrel ("smoker's paradox"). The impact of a more intensive clopidogrel regimen on ischemic and bleeding risks in smokers with acute coronary syndromes requiring percutaneous coronary interventions remains unclear. METHODS AND RESULTS: We analyzed 17 263 acute coronary syndrome patients undergoing percutaneous coronary intervention from the CURRENT-OASIS 7 (Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events-Seventh Organization to Assess Strategies in Ischemic Symptoms) trial, which compared double-dose (600 mg day 1;150 mg days 2-7; then 75 mg daily) versus standard-dose (300 mg day 1; then 75 mg daily) clopidogrel in acute coronary syndrome patients. The primary outcome was cardiovascular death, myocardial infarction, or stroke at 30 days. Interactions between treatment allocation and smoking status (current smokers versus nonsmokers) were evaluated. Overall, 6394 patients (37.0%) were current smokers. For the comparison of double- versus standard-dose clopidogrel, there were significant interactions in smokers and nonsmokers for the primary outcome (P=0.031) and major bleeding (P=0.002). Double- versus standard-dose clopidogrel reduced the primary outcome among smokers by 34% (hazard ratio [HR] 0.66, 95% confidence interval [CI], 0.50-0.87, P=0.003), whereas in nonsmokers, there was no apparent benefit (HR 0.96, 95% CI, 0.80-1.14, P=0.61). For major bleeding, there was no difference between the groups in smokers (HR 0.77, 95% CI, 0.48-1.24, P=0.28), whereas in nonsmokers, the double-dose clopidogrel regimen increased bleeding (HR 1.89, 95% CI, 1.37-2.60, P<0.0001). Double-dose clopidogrel reduced the incidence of definite stent thrombosis in smokers (HR 0.41, 95% CI, 0.24-0.71) and nonsmokers (HR 0.63, 95% CI, 0.42-0.93; P for interaction=0.19). CONCLUSIONS: In smokers, a double-dose clopidogrel regimen reduced major cardiovascular events and stent thrombosis after percutaneous coronary intervention, with no increase in major bleeding. This suggests that clopidogrel dosing in patients with acute coronary syndromes should be personalized, taking into consideration both ischemic and bleeding risk. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00335452.
- Klíčová slova
- acute coronary syndrome, antiplatelet, antiplatelet therapy, percutaneous coronary intervention, smoking, stent,
- MeSH
- akutní koronární syndrom diagnóza mortalita terapie MeSH
- časové faktory MeSH
- cévní mozková příhoda etiologie prevence a kontrola MeSH
- infarkt myokardu s elevacemi ST úseků diagnóza mortalita terapie MeSH
- inhibitory agregace trombocytů aplikace a dávkování škodlivé účinky MeSH
- Kaplanův-Meierův odhad MeSH
- klopidogrel MeSH
- koronární angioplastika * škodlivé účinky mortalita MeSH
- koronární trombóza diagnóza etiologie mortalita prevence a kontrola MeSH
- kouření škodlivé účinky mortalita MeSH
- krvácení chemicky indukované MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- proporcionální rizikové modely MeSH
- recidiva MeSH
- rizikové faktory MeSH
- rozdělení chí kvadrát MeSH
- senioři MeSH
- tendenční skóre MeSH
- tiklopidin aplikace a dávkování škodlivé účinky analogy a deriváty MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
- Názvy látek
- inhibitory agregace trombocytů MeSH
- klopidogrel MeSH
- tiklopidin MeSH
BACKGROUND: Stent thrombosis (ST) is a serious complication following coronary stenting. Intravascular optical coherence tomography (OCT) may provide insights into mechanistic processes leading to ST. We performed a prospective, multicenter study to evaluate OCT findings in patients with ST. METHODS: Consecutive patients presenting with ST were prospectively enrolled in a registry by using a centralized telephone registration system. After angiographic confirmation of ST, OCT imaging of the culprit vessel was performed with frequency domain OCT. Clinical data were collected according to a standardized protocol. OCT acquisitions were analyzed at a core laboratory. Dominant and contributing findings were adjudicated by an imaging adjudication committee. RESULTS: Two hundred thirty-one patients presenting with ST underwent OCT imaging; 14 (6.1%) had image quality precluding further analysis. Of the remaining patients, 62 (28.6%) and 155 (71.4%) presented with early and late/very late ST, respectively. The underlying stent type was a new-generation drug-eluting stent in 50.3%. Mean reference vessel diameter was 2.9±0.6 mm and mean reference vessel area was 6.8±2.6 mm2. Stent underexpansion (stent expansion index <0.8) was observed in 44.4% of patients. The predicted average probability (95% confidence interval) that any frame had uncovered (or thrombus-covered) struts was 99.3% (96.1-99.9), 96.6% (92.4-98.5), 34.3% (15.0-60.7), and 9.6% (6.2-14.5) and malapposed struts was 21.8% (8.4-45.6), 8.5% (4.6-15.3), 6.7% (2.5-16.3), and 2.0% (1.2-3.3) for acute, subacute, late, and very late ST, respectively. The most common dominant finding adjudicated for acute ST was uncovered struts (66.7% of cases); for subacute ST, the most common dominant finding was uncovered struts (61.7%) and underexpansion (25.5%); for late ST, the most common dominant finding was uncovered struts (33.3%) and severe restenosis (19.1%); and for very late ST, the most common dominant finding was neoatherosclerosis (31.3%) and uncovered struts (20.2%). In patients presenting very late ST, uncovered stent struts were a common dominant finding in drug-eluting stents, and neoatherosclerosis was a common dominant finding in bare metal stents. CONCLUSIONS: In patients with ST, uncovered and malapposed struts were frequently observed with the incidence of both decreasing with longer time intervals between stent implantation and presentation. The most frequent dominant observation varied according to time intervals from index stenting: uncovered struts and underexpansion in acute/subacute ST and neoatherosclerosis and uncovered struts in late/very late ST.
- Klíčová slova
- atherosclerosis, malapposition, stents, thrombosis, tomography, optical coherence, uncovered struts,
- MeSH
- koronární angioplastika škodlivé účinky trendy MeSH
- koronární trombóza diagnostické zobrazování epidemiologie prevence a kontrola MeSH
- lidé MeSH
- optická koherentní tomografie metody trendy MeSH
- prospektivní studie MeSH
- registrace MeSH
- senioři MeSH
- stenty uvolňující léky škodlivé účinky trendy MeSH
- výzkumná zpráva trendy MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa epidemiologie MeSH
Percutaneous catheter-based interventions became a critically important part of treatment in modern cardiology, improving quality of life as well as saving many life. Due to the introduction of foreign materials to the circulation (either temporarily or permanently) and due to a certain damage to the endothelium or endocardium, the risk of thrombotic complications is substantial and thus some degree of antithrombotic therapy is needed during all these procedures. The intensity (dosage, combination, and duration) of periprocedureal antithrombotic treatment largely varies based on the type of procedure, clinical setting, and comorbidities. This manuscript summarizes the current therapeutic approach to prevent clotting (and bleeding) during a large spectrum of interventions: acute and elective coronary interventions, acute stroke interventions and elective carotid stenting, electrophysiology procedures, interventions for structural heart disease, and peripheral arterial interventions.
- Klíčová slova
- Ablation, Anticoagulants, Antiplatelet drugs, Antithrombotic therapy, Device implantation, Percutaneous interventions, Stents, Thrombolytics,
- MeSH
- fibrinolytika terapeutické užití MeSH
- infarkt myokardu prevence a kontrola MeSH
- koronární angioplastika škodlivé účinky metody MeSH
- koronární trombóza etiologie prevence a kontrola MeSH
- lidé MeSH
- pooperační komplikace prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Názvy látek
- fibrinolytika MeSH
Renal dysfunction is a strong independent predictor of stent thrombosis. The aim of the present study was to evaluate the strength and direction of the association between kidney function and clopidogrel efficacy. The study group consisted of consecutive patients (n = 275) who underwent stent implantation. Drug efficacy was measured using the vasodilator-stimulated phosphoprotein (VASP) index 20 ± 4 hours after clopidogrel 600 mg. Nonresponse was defined as an VASP index ≥50%. Renal function was determined using serum cystatin C. The upper reference levels are 1.12 mg/L for ≤65 years of age and 1.21 mg/L for >65 years of age. Estimated glomerular filtration was calculated using cystatin C. The median value of cystatin C was 1.16 mg/L (twenty-fifth and seventy-fifth percentiles 0.96 and 1.43); 47.63% of the study population had cystatin C above reference levels and 33.1% of patients were nonresponders to clopidogrel. No correlation was found between clopidogrel efficacy assessed with the VASP index and kidney function assessed with cystatin C (Spearman r = -0.070, p = 0.248). Based on cystatin C the proportion of nonresponders to clopidogrel was 34.4% versus 31.9% (p = 0.702) in patients with impaired renal function compared to normal renal function, respectively. The proportion of clopidogrel nonresponders did not differ (p = 0.902) among groups with normal (28.8%), mildly impaired (34.8%), moderately impaired (32.9%), and severely impaired (34.8%) renal function. In conclusion, renal function assessed by cystatin C does not predict clopidogrel efficacy. Renal dysfunction is a complex entity and its significant relation to stent thrombosis cannot be explained simply by a decrease in clopidogrel efficacy.
- MeSH
- balónková koronární angioplastika metody MeSH
- cystatin C krev MeSH
- fosfoproteiny krev MeSH
- hodnoty glomerulární filtrace účinky léků fyziologie MeSH
- imunoanalýza MeSH
- inhibitory agregace trombocytů aplikace a dávkování MeSH
- klopidogrel MeSH
- koronární trombóza krev patofyziologie prevence a kontrola MeSH
- krevní proteiny MeSH
- lidé MeSH
- mikrofilamentové proteiny krev MeSH
- molekuly buněčné adheze krev MeSH
- následné studie MeSH
- nemoci koronárních tepen patofyziologie terapie MeSH
- prognóza MeSH
- senioři MeSH
- stenty MeSH
- tiklopidin aplikace a dávkování analogy a deriváty MeSH
- vyšetření funkce ledvin MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Názvy látek
- cystatin C MeSH
- fosfoproteiny MeSH
- inhibitory agregace trombocytů MeSH
- klopidogrel MeSH
- krevní proteiny MeSH
- mikrofilamentové proteiny MeSH
- molekuly buněčné adheze MeSH
- tiklopidin MeSH
- Vasodilator-Stimulated Phosphoprotein MeSH
Dual oral antiplatelet therapy, aspirin plus thienopyridine, has permitted a rapid increase in the use of coronary intervention procedures. Clopidogrel is the thienopyridine of choice for dual antiplatelet therapy in patients treated with percutaneous coronary intervention. However, there are two issues with clopidogrel: (1) clopidogrel's antiplatelet activity is delayed because the drug needs to be metabolized into its active form and (2) variability in patient response to clopidogrel has been demonstrated. To overcome these shortcomings of clopidogrel, new more potent inhibitors of P2Y12 receptors, which have a more rapid onset of action have been introduced for clinical evaluation. This article is a nonexhaustive review of the literature and concentrates on prasugrel, a third-generation, oral thienopyridine. The purpose is to summarize the current knowledge about the benefits and risks of prasugrel and to outline the most prudent strategies for the drug's clinical use.
- MeSH
- aplikace orální MeSH
- Aspirin terapeutické užití MeSH
- balónková koronární angioplastika škodlivé účinky přístrojové vybavení MeSH
- hodnocení rizik MeSH
- infarkt myokardu terapie MeSH
- inhibitory agregace trombocytů aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- klopidogrel MeSH
- kombinovaná farmakoterapie MeSH
- komplikace diabetu terapie MeSH
- koronární trombóza etiologie prevence a kontrola MeSH
- léková rezistence genetika MeSH
- lidé MeSH
- piperaziny aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- prasugrel hydrochlorid MeSH
- rizikové faktory MeSH
- stenty MeSH
- thiofeny aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- tiklopidin analogy a deriváty terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Názvy látek
- Aspirin MeSH
- inhibitory agregace trombocytů MeSH
- klopidogrel MeSH
- piperaziny MeSH
- prasugrel hydrochlorid MeSH
- thiofeny MeSH
- tiklopidin MeSH
The existence of late coronary stent thrombosis is a topical issue in cardiology today. The synoptic article discusses current definition of the above phenomenon, its delimitation in time and actual incidence. Based on data from available observation and randomised studies, long-term safety of conventional bare metal and drug-eluting stents is evaluated, as well as the safety profile following implantation. The length of thienopyridin treatment after percutaneous coronary intervention (PCI) varies according to the type of stent used. While a conventional bare metal stent (BMS) implant provides long-term safety with one month treatment, the implantation of a drug-eluting stent (DES) should be complemented with a 12-month period of clopidogrel administration. This approach may be in the future influenced by further progress in drug-eluting stents development and by prospectively acquired information on long-term administration of clopidogrel to such patients.
- MeSH
- balónková koronární angioplastika MeSH
- inhibitory agregace trombocytů terapeutické užití MeSH
- klopidogrel MeSH
- koronární trombóza etiologie prevence a kontrola MeSH
- lidé MeSH
- stenty uvolňující léky MeSH
- stenty škodlivé účinky MeSH
- tiklopidin analogy a deriváty terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- inhibitory agregace trombocytů MeSH
- klopidogrel MeSH
- tiklopidin MeSH
- MeSH
- balónková koronární angioplastika MeSH
- inhibitory agregace trombocytů terapeutické užití MeSH
- ischemická choroba srdeční terapie MeSH
- koronární restenóza MeSH
- koronární trombóza etiologie prevence a kontrola MeSH
- lidé MeSH
- stenty uvolňující léky * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- komentáře MeSH
- úvodníky MeSH
- Názvy látek
- inhibitory agregace trombocytů MeSH