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Statins interact with clopidogrel metabolism through CYP3A4, a drug interaction that has little if any clinical relevance.

Proton pump inhibitors are frequently administered in combination with DAPT to reduce the risk of gastrointestinal bleeding. European and US regulatory agencies have issued warnings regarding diminished clopidogrel action when combined with proton pump inhibitors (especially omeprazole and esomeprazole). Post hoc analyses of CREDO and TRITON-TIMI38 RCTs [ 258 ] did not show increased thromboembolic events. Accordingly, proton pump inhibitors should not be withheld when indicated.

The presence of the CYP2C19 loss-of-function allele seems to be associated with an increased risk of atherothrombotic complications in clopidogrel-treated patients. This allele does not influence the action of prasugrel on platelet function.

The extent of CKD is strongly related to the risk of adverse in-hospital outcomes. As many antithrombotic drugs are metabolized or excreted by the kidneys, an accurate assessment of renal function is required for proper dose adjustment. In general, most antithrombotic agents are contraindicated or need dose reduction in CKD patients ( Table 37 ). In patients referred for acute PCI, the first dose of an antithrombotic drug usually does not add to the risk of bleeding in cases of CKD. Repeated infusion or intake might lead to drug accumulation and increase bleeding risk. Accordingly, patients with CKD should receive the same first-line treatment as any other patient, in the absence of contraindications. Thereafter, dose adaptation is mandatory with respect to kidney function and specific antithrombotic agents may be preferred ( Table 37 ).

Management of patients on DAPT who are referred for surgical procedures depends on the level of emergency and the thrombotic and bleeding risk of the individual patient ( Figure 3 ). Most surgical procedures can be performed on DAPT or at least on ASA alone with acceptable rate of bleeding. A multidisciplinary approach is required (cardiologist, anaesthesiologist, haematologist, and surgeon) to determine the patient’s risk and to choose the best strategy.

Fig. 3
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Algorithm for pre-operative management of patients considered for/undergoing surgery treated with dual antiplatelet therapy.

Fig. 3
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Download slide

Algorithm for pre-operative management of patients considered for/undergoing surgery treated with dual antiplatelet therapy.

In surgical procedures with high to very high bleeding risk, including CABG, it is recommended that clopidogrel be stopped 5 days before surgery and ASA continued. Prasugrel should be stopped 7 days before surgery based on its prolonged and more effective action than clopidogrel. In the PLATO trial, ticagrelor was discontinued 48–72 h before surgery. DAPT should be resumed as soon as possible including a loading dose for clopidogrel and prasugrel (if possible ≪24h after operation).

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Agata Kukwa

Over 500 international startups and 300 investors will meet at the most awaited startup event in CEE, cheap sale new styles with mastercard for sale Lacoste Men’s Europa 417 1 SPM LowTop Sneakers White Wht big sale online LSgwT
, which iscelebrating its 5th anniversary this year. And it will be my first time there.

Why everyone is so excited about Pioneers? – people ask me when I sayI am off to Vienna next week. I don’t know about everyone, but here are 5 reasons of my excitement.

The meeting point

I am not the biggest fan of large scale events and usually I attend them as a speaker rather than participant. However, Pioneers Festival is really a meeting point for people from all over the Europe and people from other continents interested in the local ecoystem. I am already looking forward to see many friends from CEE. I have no idea how many coffees I will have to drink there

Startups registeredfor free

This is a practice which I truly appreciate and support. Not charging startups for participation and giving them so many added values at the same time is just awesome. Organizers say they invited 300 investors – I guess this is the only event in Europe where startups may hunt for investments without spending all their pocket money on registration fee. Pioneers charge only investors and corporates, because hey, aren’t they supposed to have some money?

Variety of super cool speakers

The agenda of Pioneers Festival looks like well-designed set of topics and personalities which will inspire, educate and motivate. However, I really want to meet Manoj Bhargava , the person whohas pledged to give away 99% of his 4 billion dollar wealth to help innovate healthcare, energy, and water for a more sustainable life. And of course Jimmy Wales , the founder of Wikipedia. I hope that Pioneers Festival media pass will make this dream come true much easier than anticipated

Diversity is the key

I’ve had an awesome chat about diversity with Lauren Napier , Communications Manager and Irregular Choice Women’s Nick of Time ClosedToe Pumps Blue Blue/Silver free shipping best seller cheap good selling zAEp9tKsKI
, Event Manager from Pioneers Festival, when interviewing them to the article Pioneers Festival Calling For Women in Tech . The subject was gender diversity, however, Lauren and Nora several times emphasized that Pioneers promotes diversity in general, which is expressed in the spectrum of nationalities, industries, expertise and opinions which are represented by invited speakers and participants.

My co-founder wanted to go

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has been talking about this event for months and, to be honest, I was not really excited about this plan. However, the closer we were getting to the event, the more people in the industry were talking about it. And this time, obliged with a media badge, I thought #letsdothis, and I decided to go as well

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