Lege Artis Medicinae

[Benefit of combined clopidogrel-aspirin platelet aggregation inhibition in acute coronary syndrome and after percutaneous coronary angioplasty]


APRIL 20, 2003

Lege Artis Medicinae - 2003;13(03)

[Platelet aggregation inhibition is equally important both in conservative and interventional cardiological treatment of acute coronary syndrome. Recently, results from three important trial were published. All three proved the efficacy of the combined aspirin + clopidogrel treatment. The basic results of the three clinical trials (CURE, PCI-CURE, CREDO) are summarized in the article. In the CURE trial the combined primary endpoint was reached in 11.4% of the patients in the control group and in 9.3% in the clopidogrel group. The relative risk reduction was 20%. The combined primary endpoint included CV mortality, MI and stroke. The treatment effect was mostly detectable in the prevention of MI and stroke. In the PCI-CURE trial 2658 patients of the CURE trial were analysed. All of them were treated by coronary angioplasty. In this group the primary endpoint (CV death, nonfatal MI, urgent revascularisation) was reached in 6.4% of the aspirin treated and in 4.5% of the aspirin + clopidogrel treated patients. The relative risk reduction was 30%. The CREDO trial investigated patients after coronary angioplasty. The indication of angioplasty was either acute or chronic. All patients received combined aspirin + clopidogrel but only for four weeks in the control group or for one year in the treatment group. The combined primary endpoint was decreased by 26.9%. In all the 3 trials the risk of bleeding was slightly but significantly increased by the combined aspirin + clopidogrel treatment. Clinical application: based on the results of the 3 trials it is concluded that combined aspirin + clopidogrel treatment is indicated in all patients with acute coronary syndrome, independently from the treatment strategy. The treatment should be continued for one year. This is also applicable for all patients treated with coronary angioplasty.]



Further articles in this publication

Lege Artis Medicinae

[Severe acute respiratory syndrome]


Lege Artis Medicinae

[VIII. National Congress on Antibiotics]


Lege Artis Medicinae

[Proteomics - the new challenge]


[The term ”proteome” (proteome, PROTEin complement to a genOME) by now a generally accepted expression in biomedical science meaning a complete complements of proteins. The discipline ”proteomics”, coined after proteome, deals with the analysis of the complete set of proteins occurring in the living organism. This includes the identification and quantification of proteins, the determination of protein localisation, modifications, interactions, activities and function. Performing comparative studies is an important part of proteomics for the analysis of proteins in health and disease. The knowledge generated is already used for improved diagnostic procedures and development of new drugs and therapies. During the proteome analysis, as outlined in this paper, even very small quantities (concentrations) of proteins are measured, then the protein is identified and its structure is elucidated. This procedure is followed by functional studies. An important part of proteomics is the collection and validation of numerical databases suitable for data mining. There is a general understanding that methodology driven research (e.g. NMR, mass spectrometry, DNA chips) is also an integrated part of this discipline. It is already sensed that the analysis of proteome can lead to the discovery of new proteins proving targets for drug research and to the establishment of new procedures with a perspective of improved diagnosis and therapy.]

Lege Artis Medicinae

[Extraintestinal manifestations in inflammatory bowel diseases]


[Inflammatory bowel diseases (IBD) are systemic disorders. Bowel symptoms are the predominant manifestations, however during the course of the disease a lot of intestinal and extraintestinal complications may occur. Systemic complications are responsible for substantial co-morbidity and they have negative influence on the quality of life. A part of the extraintestinal symptoms seem to have common pathogenetic background with IBD, while others are the consequences of subsequent metabolic and endocrine abnormalities or may relate to local complications and adverse effects of treatment. Growing evidence is available on the role of genetic and immunologic factors in the pathogenesis of extraintestinal manifestations. Most important systemic complications are: peripheral and axial arthritides, osteoporosis, uveitis, erythema nodosum, pyoderma gangraenosum, primary sclerosing cholangitis, nonalcoholic steatohepatitis, different types of anaemia, thromboembolism, kidney stones and urinary complications. Cooperation with the specialists is very important in the diagnosis and treatment of these comlications. During followup of IBD patients special attention is needed to monitor possible extraintestinal manifestations.]

Lege Artis Medicinae

[Terbinafine (Lamisil) treatment of toenail onychomycosis in patients with insulin-dependent and non-insulin-dependent diabetes mellitus: a multicentre trial]


All articles in the issue

Related contents

Lege Artis Medicinae

[Perioperative management of patients with coronary stent in case of interventions other than cardiac surgery - Part I. - Perioperative treatment of patients with coronary stent]

ZIMA Endre, MEZŐFI Miklós, BECKER Dávid, SZABÓ György, MERKELY Béla, PÉNZES István

[Percutaneous coronary intervention (PCI) is meant to optimalise cardiac status, that is, short-term and long-term outcomes. It is known from large Western databases that stent implantation is performed in 77-85% of coronary interventions, which means hundreds of thousands of new patients with stent every year. The great majority of these patients has to take platelet aggregation inhibitors, namely acetylsalicylic acid and thienopyridin, most often clopidrogel. It presents a major therapeutic dilemma when these patients require noncardiac surgery. First, surgery should be performed with the least possible blood loss, which would be optimal if the platelet aggregation inhibitor therapy - that is indispensable for a certain period because of the stent - was suspended. Second, stent thrombosis has to be avoided, which can only be achieved if platelet aggregation inhibitor therapy is continued. The aim of our paper is to summarise the current guidelines and the risk estimation on the basis of our current knowledge in the perioperative management of patients with coronary stent. In the first part, we overview the platelet aggregation inhibitor agents, their mechanisms of effect, stent types and the minimal therapeutic period to be strictly observed, which depends on the type of stent.]

Lege Artis Medicinae

[Percutaneous coronary intervention in ischaemic heart disease]

VOITH László

[In ischaemic heart disease, if the medically treated patient’s anginal complaints and/or ischaemic symptoms are persistent, coronary angiography, and according to its results, coronary intervention (surgery or dilatation) may become necessary. The intervention is required in critical stenosis (>70% diameter) of the main vessels, the emergency depends on the clinical situation. Basic method of coronary angioplasty is the balloon dilatation, other tools (stent, rotablator, laser wire, atherectomy device, etc.) are also available. Periprocedural anticoagulant (heparin) and platelet aggregation inhibitor (aspirin, ticlopidine, GP IIb/III/a receptor blocker) treatment is required, the latter after the procedure as well. After stent implantation the lumen of the vessel is bigger and the incidence of major adverse cardiac events (acute myocardial infarction, repeated intervention, fatal outcome) is diminished. Decrease of serum lipid level improves the outcome of coronary angioplasty. It is applicable successfully for multiple lesions, occluded vessels, stable and unstable angina, in the early phase of myocardial infarction, in patients who underwent coronary surgery, and in old age too. Risk factors of the intervention are: tortuous vessel, significant calcification, stenosis in angle or ostium, luminal thrombus, urgent intervention, old age, female gender, congestive heart failure, unstable condition and acute myocardial infarction. When indicating the intervention, besides the probable results, it is necessary to consider the possibility of complications (myocardial infarction, malignant rhythm disorders, acute heart failure, bleeding, etc.). In left main stem stenosis, 3 vessel disease and in the case of 1 functioning coronary artery surgery would be preferable. With the present facilities the ratio of urgent surgical intervention as well as the mortality is below 1%.]

Clinical Neuroscience

[MR investigations in stroke]

KENÉZ József, BARSI Péter

[In the article digital imaging methods are presented with special emphasis on the use on diagnostics of cerebral circulation studies. Recently, fundamental changes have happened in this field, concerning especially the MR investigations. These changes have influenced the therapeutic strategies of ischaemic stroke. Authors give the theoretical background on the diffusion and perfusion MR imaging, emphasising the importance of their “mismatch” and its impact in the estimation of the outcome of ischaemic events. More recently, new, controversial facts arose, regarding the reasons of the introduction of the theory of so called “negative” and “positive” mismatches. As a consequence, a level of uncertainty took place in the judgement of prognostics. The leading institutions are searching the way to solve the problem which seems to be the quantitative evaluation of the diffusion, perfusion and mismatch data. The advent of the multislice spiral CT with very fast imaging and the importance of CT investigations increased. With this new kind of equipment, even perfusion studies can be performed using iodinated contrast medium.]

Lege Artis Medicinae

[Perioperative management of patients with coronary stent undergoing noncardiac surgical procedures - Part II. - Algorythm of emergency and perioperative treatment decisions]

ZIMA Endre, MEZŐFI Miklós, BECKER Dávid, SZABÓ György, MERKELY Béla, PÉNZES István

[The aim of percutaneous coronary intervention (PCI) is to optimise coronary and cardial status, and thus improve short- and long-term outcomes. It is known from large Western databases that stent implantation is performed during 77-85% of coronary interventions, which means hundreds of thousands of patients with new stent every year. The majority of patients need to take dual platelet aggregation inhibitor, namely acetyilsalicylic acid and thienopyridin - most often clopidrogel - following stent implantation. It presents a major therapeutic dilemma when these patients need noncardiac surgery. First, the surgery should be performed with the least blood loss possible, which would be optimally achieved by suspension of the platelet aggregation inhibitor therapy that cannot be stopped during the critical period after stent implantation. Second, stent thrombosis should be avoided, which can only be achieved if platelet aggregation inhibitor therapy is continued. The aim of our paper is to summarise the current professional guidelines and the current risk estimation in the perioperative management of patients with coronary stent. In the second part of the article, we summarise the preoperative preparation of the patient, assessment of coronary status and cardial medication, and the optimal time and location of the surgery. We present the decision principles regarding the risks of perioperative bleeding and stent thrombosis, and the need to continue platelet aggregation inhibitor therapy.]

Lege Artis Medicinae



[Recently the indications of percutaneous coronary intervention have changed both in the ST elevation and in the non-ST elevation, unstable angina group of acute coronary syndrome. Current indications in these groups are briefly reviewed and the outcomes and indications of primary interventions or those following successful or unsuccessful thrombolysis are discussed based on the most recent guidelines. Of the technical aspects, experience of the person performing the intervention, the issue of stent implantation or balloon expansion, and protection against embolism are mentioned.]