Publications by authors named "Wout van den Broek"
Article Synopsis
- The study investigates the frequency and reasons for changes in ticagrelor treatment among patients with acute coronary syndrome (ACS), revealing that many patients discontinue it prematurely.
- Data from over 4,200 patients showed that 26.7% had physician-recommended discontinuations and 20.1% had alterations in their treatment within a year.
- Treatment interruptions and disruptions significantly increased the risk of serious heart-related issues, while discontinuation and alterations did not show the same level of risk.
Article Synopsis
- The effectiveness and safety of antiplatelet medications can differ from person to person, which means some patients might face a higher risk of recurring health issues while on treatment.
- This variability is often linked to genetic differences that affect how these drugs are metabolized in the body, a topic explored by pharmacogenomics.
- Personalized treatment choices based on genetic testing, particularly focusing on CYP2C19 variants, can optimize therapy, but despite the promising results, few hospitals have adopted these tailored strategies so far.
Article Synopsis
- The study investigated whether using CYP2C19 genetic testing to guide medication choices improves outcomes for patients with acute coronary syndrome (ACS) compared to standard treatment.
- Out of 5,321 ACS patients, those who were genotyped and had their medications tailored showed significantly lower bleeding rates while maintaining a similar risk of ischemic events compared to those on standard therapy.
- The findings suggest that a personalized approach to antiplatelet therapy based on genetic markers can enhance safety without compromising efficacy in managing ACS.
Article Synopsis
- The optimal management of patients with atrial fibrillation (AF) requiring oral anticoagulation (OAC) during percutaneous coronary intervention (PCI) is debated, with current guidelines suggesting a temporary triple therapy regimen that includes aspirin, which raises bleeding risks.
- A new study, the WOEST-3 trial, seeks to compare a 30-day dual antiplatelet therapy (DAPT) strategy that temporarily omits OAC against guideline-directed therapy post-PCI for AF patients, aiming to reduce bleeding without sacrificing efficacy.
- With a sample of 2,000 patients, the trial will evaluate the rates of major bleeding and adverse ischemic events, making it the first randomized controlled trial to explore the omission of OAC
Background: Among patients treated with a novel oral anticoagulant (NOAC) undergoing percutaneous coronary intervention (PCI), combination therapy with clopidogrel (ie, known as dual antithrombotic therapy [DAT]) is the treatment of choice. However, there are concerns for individuals with impaired response to clopidogrel.
Objectives: The authors sought to assess the pharmacodynamic (PD) effects of clopidogrel vs low-dose ticagrelor in patients with impaired clopidogrel response assessed by the ABCD-GENE score.
Objective: We describe the current treatment of elderly patients with non-ST-elevation myocardial infarction (NSTEMI) enrolled in a national registry.
Methods: The POPular AGE registry is a prospective, multicentre study of patients ≥ 75 years of age presenting with NSTEMI, performed in the Netherlands. Management was at the discretion of the treating physician.
This registry assessed the impact of conservative and invasive strategies on major adverse clinical events (MACE) in elderly patients with non-ST-elevation myocardial infarction (NSTEMI). Patients aged ≥75 years with NSTEMI were prospectively registered from European centers and followed up for one year. Outcomes were compared between conservative and invasive groups in the overall population and a propensity score-matched (PSM) cohort.
View Article and Find Full Text PDFOn 8-9 November 2022, the European Society of Pharmacogenomics and Personalised Therapy organized its sixth biennial congress, in Belgrade, Serbia (congress website: www.sspt.rs).
View Article and Find Full Text PDFThe Fourth Maastricht Consensus Conference on Thrombosis included the following themes. Theme 1: The "coagulome" as a critical driver of cardiovascular disease. Blood coagulation proteins also play divergent roles in biology and pathophysiology, related to specific organs, including brain, heart, bone marrow, and kidney.
View Article and Find Full Text PDFAims: Dual-antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 inhibitor is the standard treatment for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). De-escalation of the potent P2Y12 inhibtor is an appealing concept to balance the ischaemic and bleeding risks after PCI. An individual patient data meta-analysis was performed to compare de-escalation versus standard DAPT in patients with ACS.
View Article and Find Full Text PDFBackground: The cytochrome P450 (CYP) 2C9 enzyme plays a role in the metabolization of clopidogrel. Carriage of a CYP2C9 loss-of-function (LoF) allele has been associated with attenuated pharmacokinetics, leading to a diminished pharmacodynamic response and increased risk for developing stent thrombosis in patients treated with clopidogrel.
Methods: In this study, we aimed to determine the effect of the CYP2C9*2 and *3 LoF alleles on thrombotic events.
Article Synopsis
- The study aimed to assess the clinical efficacy and side effects of ticagrelor in patients with varying CYP3A5 gene status, specifically looking at thrombotic and bleeding events, as well as dyspnea.
- A total of 1,281 STEMI patients were genotyped, revealing no significant differences in thrombotic or bleeding outcomes between carriers and non-carriers of the gene, nor between CYP3A5 expressors and non-expressors.
- Overall, ticagrelor showed no statistical significance in affecting thrombotic events, bleeding rates, or dyspnea among the different genetic groups studied.
The population of elderly with cardiovascular diseases and multimorbidity is rapidly growing. For decades, different antithrombotic therapies have been studied to find the most effective therapy in reducing the risk of cardiovascular events. Recently, large trials have investigated a new antithrombotic therapy consisting of a platelet aggregation inhibitor and a low-dose anticoagulant (aspirin plus rivaroxaban).
View Article and Find Full Text PDFObjective: The POPular AGE trial showed that clopidogrel significantly reduced bleeding risk compared with ticagrelor without any signs of an increase in thrombotic events. The aim of this analysis was to estimate the long-term cost-effectiveness of clopidogrel compared with ticagrelor in these patients aged 70 years or older with non-ST-elevation acute coronary syndrome (NSTE-ACS).
Methods And Results: A 1-year decision tree based on the POPular AGE trial in combination with a lifelong Markov model was developed to compare clopidogrel with ticagrelor in terms of clinical outcomes, costs, and quality-adjusted life years (QALYs) in elderly patients (above 70 year) with NSTE-ACS.
Global Longitudinal Strain is Incremental to Left Ventricular Ejection Fraction for the Prediction of Outcome in Optimally Treated Dilated Cardiomyopathy Patients.
J Am Heart Assoc
March 2022
Background Speckle tracking echocardiographic global longitudinal strain (GLS) predicts outcome in patients with new onset heart failure. Still, its incremental value on top of left ventricular ejection fraction (LVEF) in patients with nonischemic, nonvalvular dilated cardiomyopathy (DCM) after optimal heart failure treatment remains unknown. Methods and Results Patients with DCM were included at the outpatient clinics of 2 centers in the Netherlands and Italy.
View Article and Find Full Text PDFAlthough current literature indicates both a clinical and a cost-effective benefit of routine genotype-guided treatment of patients treated with clopidogrel, this strategy is not recommended in guidelines. In cardiology, but also in neurology and vascular surgery, the current scientific evidence for this is still insufficient. Nevertheless, the role of pharmacogenetics will gain importance in today's medical world, where the demand for personalised medicine is on the rise.
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