Chronic stable angina treatment dipyridamole: Difference between revisions
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{{Chronic stable angina}} | {{Chronic stable angina}} | ||
'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto: | '''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[John Fani Srour, M.D.]]; [[WikiDoc Scholars#WikiDoc Scholars with Distinction|Jinhui Wu, M.D.]]; [[Lakshmi Gopalakrishnan|Lakshmi Gopalakrishnan, M.B.B.S.]] | ||
==Overview== | ==Overview== | ||
Dipyridamole is a pyrimidopyrimidine derivative with | Dipyridamole is a pyrimidopyrimidine derivative with poor anti-thrombotic efficacy and therefore not recommended for anti-platelet therapy in patients with chronic stable angina.<ref name="pmid11786451">Antithrombotic Trialists' Collaboration (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11786451 Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients.] ''BMJ'' 324 (7329):71-86. PMID: [http://pubmed.gov/11786451 11786451]</ref> Dipyridamole may also exacerbate anginal symptoms due to coronary steal phenomenon.<ref name="pmid10860181">Kaufmann PA, Mandinov L, Seiler C, Hess OM (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10860181 Impact of exercise-induced coronary vasomotion on anti-ischemic therapy.] ''Coron Artery Dis'' 11 (4):363-9. PMID: [http://pubmed.gov/10860181 10860181]</ref> | ||
==Mechanisms of | ==Dipyridamole== | ||
===Mechanisms of Benefit=== | |||
*Dipyridamole is a pyrimido-pyrimidine derivative. | *Dipyridamole is a pyrimido-pyrimidine derivative. | ||
*Dipyridamole exerts vasodilator effects on coronary resistance vessels. | *Dipyridamole exerts vasodilator effects on coronary resistance vessels. | ||
== | ===Contraindications=== | ||
Dipyridamole enhances | Dipyridamole enhances exercise-induced myocardial ischemia even the usual oral dosage and hence it not used as an anti-platelet agent in patients with stable angina. | ||
==Adverse | ===Adverse Effects=== | ||
*[[Myocardial ischemia|Exercise induced myocardial ischemia]] | *[[Myocardial ischemia|Exercise induced myocardial ischemia]] | ||
*Exacerbation of anginal symptoms | *Exacerbation of anginal symptoms | ||
| Line 20: | Line 22: | ||
*[[Bronchospasm]] | *[[Bronchospasm]] | ||
==Supportive | ===Supportive Trial Data=== | ||
In a post hoc analysis that investigated cardiac events in patients with [[coronary heart disease]] or [[MI]] at study entry, [[dipyridamole]] therapy did not result in a higher number of cardiac events such as [[angina pectoris]], [[MI]] or death from all causes. | In a post hoc analysis that investigated cardiac events in patients with [[coronary heart disease]] or [[MI]] at study entry, [[dipyridamole]] therapy did not result in a higher number of cardiac events such as [[angina pectoris]], [[MI]] or death from all causes.<ref name="pmid11351768">Diener HC, Darius H, Bertrand-Hardy JM, Humphreys M, European Stroke Prevention Study 2 (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11351768 Cardiac safety in the European Stroke Prevention Study 2 (ESPS2).] ''Int J Clin Pract'' 55 (3):162-3. PMID: [http://pubmed.gov/11351768 11351768]</ref> | ||
==ACC/AHA Guidelines | ==2012 ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid23166210">{{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2012 | volume= 126 | issue= 25 | pages= 3097-137 | pmid=23166210 | doi=10.1161/CIR.0b013e3182776f83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23166210 }} </ref>== | ||
== | ===Dipyramidole (DO NOT EDIT)<ref name="pmid23166210">{{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2012 | volume= 126 | issue= 25 | pages= 3097-137 | pmid=23166210 | doi=10.1161/CIR.0b013e3182776f83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23166210 }} </ref><ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref>=== | ||
== | {|class="wikitable" | ||
|- | |||
|colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit) | |||
|- | |||
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Dipyridamole is not recommended as antiplatelet therapy for patients with SIHD. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | |||
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==References== | ==References== | ||
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{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
[[Category:Disease]] | |||
[[Category:Ischemic heart diseases]] | [[Category:Ischemic heart diseases]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Intensive care medicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Up-To-Date cardiology]] | [[Category:Up-To-Date cardiology]] | ||
Latest revision as of 18:54, 31 October 2016
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Chronic stable angina Microchapters | ||
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Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Diagnosis | ||
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Alternative Therapies for Refractory Angina | ||
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Discharge Care | ||
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Guidelines for Asymptomatic Patients | ||
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Case Studies | ||
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Chronic stable angina treatment dipyridamole On the Web | ||
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to Hospitals Treating Chronic stable angina treatment dipyridamole | ||
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Risk calculators and risk factors for Chronic stable angina treatment dipyridamole | ||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]; John Fani Srour, M.D.; Jinhui Wu, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Dipyridamole is a pyrimidopyrimidine derivative with poor anti-thrombotic efficacy and therefore not recommended for anti-platelet therapy in patients with chronic stable angina.[1] Dipyridamole may also exacerbate anginal symptoms due to coronary steal phenomenon.[2]
Dipyridamole
Mechanisms of Benefit
- Dipyridamole is a pyrimido-pyrimidine derivative.
- Dipyridamole exerts vasodilator effects on coronary resistance vessels.
Contraindications
Dipyridamole enhances exercise-induced myocardial ischemia even the usual oral dosage and hence it not used as an anti-platelet agent in patients with stable angina.
Adverse Effects
- Exercise induced myocardial ischemia
- Exacerbation of anginal symptoms
- Hypotension
- Headache
- Bronchospasm
Supportive Trial Data
In a post hoc analysis that investigated cardiac events in patients with coronary heart disease or MI at study entry, dipyridamole therapy did not result in a higher number of cardiac events such as angina pectoris, MI or death from all causes.[3]
2012 ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)[4]
Dipyramidole (DO NOT EDIT)[4][5]
| Class III (No Benefit) |
| "1. Dipyridamole is not recommended as antiplatelet therapy for patients with SIHD. (Level of Evidence: B) " |
References
- ↑ Antithrombotic Trialists' Collaboration (2002) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324 (7329):71-86. PMID: 11786451
- ↑ Kaufmann PA, Mandinov L, Seiler C, Hess OM (2000) Impact of exercise-induced coronary vasomotion on anti-ischemic therapy. Coron Artery Dis 11 (4):363-9. PMID: 10860181
- ↑ Diener HC, Darius H, Bertrand-Hardy JM, Humphreys M, European Stroke Prevention Study 2 (2001) Cardiac safety in the European Stroke Prevention Study 2 (ESPS2). Int J Clin Pract 55 (3):162-3. PMID: 11351768
- ↑ 4.0 4.1 Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP; et al. (2012). "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 126 (25): 3097–137. doi:10.1161/CIR.0b013e3182776f83. PMID 23166210.
- ↑ Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. [1] PMID: 10351980