clopidogrel besylate (Plavid)

Nationwide Claims-Based Incidence and Associated Factors of Adverse Events after Gastric Endoscopic Submucosal Dissection.

Kim Jung-Wook JW, Jang Jae-Young JY, Lee Tae-Hee TH, Choi Hyuk Soon HS et al.

Most data on adverse events (AEs) following gastric endoscopic submucosal dissection (ESD) originate from high-volume expert centers, limiting their generalizability to routine clinical practice. Population-level claims-based evidence on AEs after gastric ESD remains limited, although such data cannot fully account for lesion- and procedure-specific risk factors. We conducted a nationwide, retrospective cohort study using claims data from the Korean Health Insurance Review and Assessment Service. All patients who underwent ESD for gastric neoplastic lesions between 2013 and 2017 were included. Claims-defined AEs-including bleeding, perforation, pneumonia, and intensive care unit (ICU) admission within 30 days-were assessed, along with subsequent gastric surgery within 90 days. Multivariable logistic regression was used to identify factors associated with each outcome. A total of 83,871 gastric ESD procedures were performed in 76,181 patients. The incidence of bleeding was 16.6%, whereas perforation (0.17%), pneumonia (0.65%), and ICU admission (0.94%) were uncommon. Older age was associated with a lower risk of bleeding but a higher risk of pneumonia and ICU admission, particularly among patients aged ≥80 years. Among the antithrombotic agents included in the analysis, warfarin was associated with bleeding and clopidogrel was associated with ICU admission. Procedures performed at general hospitals were associated with higher risks of multiple AEs compared with those performed at tertiary centers. Overall, 3.9% of patients underwent additional gastric surgery, almost exclusively among those with gastric cancer. In this nationwide population-based claims study, claims-defined AEs after standard-indication gastric ESD were associated with patient-level and institution-level variables available in administrative data (cris.nih.go.kr, KCT0011604).

Comment on "Real-world long-term outcomes of clopidogrel-based dual antiplatelet therapy post-drug-eluting stent implantation in all comers patients: A retrospective evaluation".

Dhangar Sanjay P SP, Muralidhar Sushmita D SD

Tirofiban vs standard antiplatelet therapy in acute branch atheromatous disease-related stroke: a multicenter, randomized, open-label, blinded-endpoint, parallel-group, phase III clinical trial.

Li Shengde S, Hu Haizhou H, Zhang Dingding D, Liu Bin B et al.

Tirofiban is sometimes used empirically for branch atheromatous disease (BAD)-related stroke, but its benefit in this population remains unclear. This study aimed to assess the efficacy and safety of intravenous tirofiban administered within 48 h of onset in patients with acute BAD-related stroke. This multicentre, randomized, open-label, blinded-endpoint clinical trial enrolled patients with BAD-related stroke within 48 h of onset from 25 hospitals in China between 9 November 2023 and 22 November 2025. Eligible patients were randomly assigned to the tirofiban group (intravenously, 0.4 μg/kg per minute for 30 min, followed by a 0.1 μg/kg per minute for 47.5 h) or standard antiplatelet therapy group (oral aspirin with or without clopidogrel) for 48 h. The primary endpoint was an excellent functional outcome, defined as a score of 0 or 1 on the modified Rankin Scale at 90 days. Safety outcomes included major bleeding within 90 days. This trial was registered on ClinicalTrials.gov (NCT06037889). Among 516 patients randomized, 513 were included in the primary analysis (258 with tirofiban and 255 with standard antiplatelet therapy). An excellent functional outcome was observed in 181 of 258 patients (70.2%) in the tirofiban group and 178 of 255 (69.8%) in the standard antiplatelet therapy group (risk ratio, 1.01 [95% CI, 0.90-1.13]; P = 0.93). Major bleeding occurred in 0 of 259 participants in the tirofiban-exposed safety population and 1 of 245 (0.4%) in the standard-antiplatelet-exposed safety population. Among patients with acute BAD-related stroke, intravenous tirofiban administered within 48 h of onset without concomitant oral antiplatelet therapy was not superior to standard antiplatelet therapy for achieving an excellent functional outcome at 90 days. These findings should not be extrapolated to substantially earlier treatment or to other tirofiban-based antiplatelet strategies. National High Level Hospital Clinical Research Funding, Capital's Funds for Health Improvement and Research, CAMS Innovation Fund for Medical Sciences (CIFMS), Noncommunicable Chronic Diseases-National Science and Technology Major Project, and China Shijiazhuang Pharmaceutical Company (CSPC) NBP Pharmaceurical Co., Ltd.

Intravascular Ultrasound-Guided Iliofemoral Venous Stenting: In-Stent Mural Thrombus as a Possible Early Sign of Occult Malignancy.

Tada Yuki Y, Kikuchi Shinsuke S, Uramoto Takayuki T, Kuriyama Naoya N et al.

Dedicated venous stents became available in Japan only recently, and reports of their use and follow-up in Japanese practice remain scarce. A 77-year-old woman developed acute left iliofemoral deep vein thrombosis (DVT) after prolonged recumbency and was treated with edoxaban. Eighteen days later she underwent endovascular therapy of the right lower limb for chronic limb-threatening ischaemia, and aspirin was added. Limb swelling and pain persisted despite three months of anticoagulation and graduated compression, and imaging then showed chronic occlusion of the left common and external iliac veins (EIV) with patent femoral and deep femoral inflow, corresponding to a favourable anatomical category of chronic venous obstruction (CVO). Under intravascular ultrasound (IVUS) guidance, which identified a stenotic distal landing zone in the proximal common femoral vein (CFV) that was not evident on venography, two Venovo venous stents (Becton, Dickinson and Company (BD), Tempe, AZ, USA) were deployed from the common iliac vein (CIV) to the CFV. Symptoms and clinical severity scores improved over the following months. Three months after stenting, duplex surveillance detected a localised mural thrombus along the posterior wall of the stent despite treatment with edoxaban and aspirin; the antiplatelet agent was changed to clopidogrel, yet the thrombus enlarged from 3 to 6 mm over the next six months before reaching a plateau. Nine months after stenting, an occult breast carcinoma was diagnosed incidentally. The stent remained patent at 12 months, through two bleeding events and three interruptions of antithrombotic therapy. This case illustrates one approach to managing an asymptomatic in-stent mural thrombus and raises the possibility that a thrombus forming despite adequate antithrombotic therapy may be an early manifestation of an undiagnosed malignancy.