Alan D. Bell
University of Toronto
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Publication
Featured researches published by Alan D. Bell.
Canadian Journal of Cardiology | 2011
Alan D. Bell; André Roussin; Raymond Cartier; Wee Shian Chan; James D. Douketis; Anil Gupta; Maria E. Kraw; Thomas F. Lindsay; Michael P. Love; Neesh Pannu; Rémi Rabasa-Lhoret; Ashfaq Shuaib; Philip Teal; Pierre Theroux; Alexander G.G. Turpie; Robert C. Welsh; Jean-François Tanguay
Antiplatelet agents are a cornerstone of therapy for patients with atherosclerotic vascular disease. There is presently a lack of comprehensive guidelines focusing on the use of antiplatelet drugs in patients currently manifesting or at elevated risk of cardiovascular disease. The Canadian Antiplatelet Therapy Guidelines Committee reviewed existing disease-based guidelines and subsequently published literature and used expert opinion and review to develop guidelines on the use of antiplatelet therapy in the outpatient setting. This full document has been summarized in an Executive Summary published in the Canadian Journal of Cardiology and may be found at http://www.ccs.ca/. Antiplatelet therapy appears to be generally underused, perhaps in part because of a lack of clear, evidence-based guidance. Here, we provide specific guidelines for secondary prevention in patients discharged from hospital following acute coronary syndromes, post-percutaneous coronary intervention, post-coronary artery bypass grafting, patients with a history of transient cerebral ischemic events or strokes, and patients with peripheral arterial disease. Issues related to primary prevention are also addressed, in addition to special clinical contexts such as diabetes, heart failure, chronic kidney disease, pregnancy/lactation, and perioperative management. Recommendations are provided regarding pharmacologic interactions that may occur during combination therapy with warfarin, clopidogrel and proton-pump inhibitors, or acetylsalicylic acid and nonsteroidal anti-inflammatory drugs, as well as for the management of bleeding complications.
Canadian Journal of Cardiology | 2013
Jean-François Tanguay; Alan D. Bell; Margaret L. Ackman; Robert D.C. Bauer; Raymond Cartier; Wee-Shian Chan; James D. Douketis; André Roussin; Gregory Schnell; Subodh Verma; Graham C. Wong; Shamir R. Mehta
The initial 2010 Canadian Cardiovascular Society (CCS) Guidelines for the Use of Antiplatelet Therapy in the Outpatient Setting were published in May 2011. As part of a planned re-evaluation within 2 years, we conducted an extensive literature search encompassing all topics included in the 2010 CCS Guidelines, and concluded that there were sufficient new data to merit revisiting the guidance on antiplatelet therapy for secondary prevention in the first year after acute coronary syndrome (ACS), percutaneous coronary intervention, or coronary artery bypass grafting, and the interaction between clopidogrel and proton pump inhibitors. In addition, new clinical trials information about the efficacy and safety of combining novel oral anticoagulants with antiplatelet therapy in ACS justified the addition of a new section of recommendations to the Guidelines. In this focused update, we provide recommendations for the use of clopidogrel, ticagrelor, and prasugrel in non-ST elevation ACS, avoidance of prasugrel in patients with previous stroke/transient ischemic attack, higher doses of clopidogrel (j) /day) for the first 6 days after ACS, and the preferential use of prasugrel or ticagrelor after percutaneous coronary intervention in ACS. For non-ACS stented patients, we recommend acetylsalicylic acid/clopidogrel for 1 year, with at least 1 month of therapy for bare-metal stent patients and 3 months for drug-eluting stent patients unable to tolerate year-long double therapy. We also consider therapy for patients with a history of stent thrombosis, the indications for longer-term treatment, discontinuation timing preoperatively, indications for changing agents, the management of antiplatelet therapy before and after bypass surgery, and use/selection of proton pump inhibitors along with antiplatelet agents.
Canadian Journal of Cardiology | 2011
Alan D. Bell; André Roussin; Raymond Cartier; Wee Shian Chan; James D. Douketis; Anil Gupta; Maria E. Kraw; Thomas F. Lindsay; Michael P. Love; Neesh Pannu; Rémi Rabasa-Lhoret; Ashfaq Shuaib; Philip Teal; Pierre Theroux; A. Graham Turpie; Robert C. Welsh; Jean-François Tanguay
Antiplatelet agents are a cornerstone of therapy for patients with atherosclerotic vascular disease. There is presently a lack of comprehensive guidelines focusing on the use of antiplatelet drugs in patients currently manifesting or at elevated risk of cardiovascular disease. The Canadian Antiplatelet Therapy Guidelines Committee reviewed existing disease-based guidelines and subsequently published literature and used expert opinion and review to develop guidelines on the use of antiplatelet therapy in the outpatient setting. This Executive Summary provides an abbreviated version of the principal recommendations. Antiplatelet therapy appears to be generally underused, perhaps in part because of a lack of clear, evidence-based guidance. Here, we provide specific guidelines for secondary prevention in patients discharged from hospital after acute coronary syndromes, percutaneous coronary intervention, or coronary artery bypass grafting; patients with a history of transient cerebral ischemic events or strokes; and patients with peripheral arterial disease. Issues related to primary prevention are also addressed, in addition to special clinical contexts such as diabetes, heart failure, chronic kidney disease, pregnancy or lactation, and perioperative management. Recommendations are provided regarding pharmacologic interactions that may occur during combination therapy with warfarin, clopidogrel, and proton-pump inhibitors, or aspirin and nonsteroidal anti-inflammatory drugs, as well as for the management of bleeding complications. The complete guidelines document is published as a supplementary issue of the Canadian Journal of Cardiology and is available at http://www.ccs.ca/.
Canadian Medical Association Journal | 2009
Alan Kaplan; Meyer Balter; Alan D. Bell; Harold Kim; McIvor Ra
Sara is a 41-year-old secretary in an autobody shop who comes to see you for evaluation of intermittent episodes of wheeze and shortness of breath that have progressed over the past 2 years. She feels that she has more “colds” than her workplace colleague, each of which lasts for 2–3 weeks,
Canadian Journal of Cardiology | 2015
Laurent Macle; John A. Cairns; Jason G. Andrade; L. Brent Mitchell; Stanley Nattel; Atul Verma; Jason Andrade; Clare L. Atzema; Alan D. Bell; Stuart J. Connolly; Jafna L. Cox; Paul Dorian; David J. Gladstone; Jeff S. Healey; Kori Leblanc; Ratika Parkash; Louise Pilote; Mike Sharma; Allan C. Skanes; Mario Talajic; Teresa S.M. Tsang; Subodh Verma; David J. Bewick; Vidal Essebag; Peter G. Guerra; Brett Heilbron; Charles R. Kerr; Bob Kiaii; George Klein; Simon Kouz
The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Program has generated a comprehensive series of documents regarding the management of atrial fibrillation (AF) between 2010 and 2014. The guidelines provide evidence-based consensus management recommendations in a broad range of areas. These guidelines have proven useful in informing clinical practice, but often lack detail in specifications related to practical application, particularly for areas in which the evidence base is limited or conflicting. Based on feedback from the community, the CCS Atrial Fibrillation Guidelines Committee has identified a number of areas that require clarification to address commonly asked practical questions related to guidelines application. In the present article a number of such questions are presented and suggestions about how they can be answered are suggested. Among the issues considered are: (1) What duration of AF is clinically significant? (2) How are the risk factors in the CCS Algorithm for selecting anticoagulation therapy derived and defined? (3) How is valvular heart disease defined and how do different forms of valve disease affect the choice of anticoagulant therapy for AF patients? (4) How should we quantify renal dysfunction and how does it affect therapeutic choices? The response to these questions and the underlying logic are provided, along with an indication of future research needed where no specific approach can presently be recommended based on the literature.
Canadian Journal of Cardiology | 2010
Kim G. Smolderen; Alan D. Bell; Yang Lei; Eric A. Cohen; P. Gabriel Steg; Deepak L. Bhatt; Elizabeth M. Mahoney
BACKGROUND AND OBJECTIVES To provide a contemporary estimate of the economic burden of atherothrombosis in Canada, annual cardiovascular-related hospitalizations, medication use and associated costs across the entire spectrum of atherothrombotic disease were examined. METHODS The REduction of Atherothrombosis for Continued Health (REACH) registry enrolled 1964 Canadian outpatients with coronary artery disease, cerebrovascular disease or peripheral arterial disease (PAD), or three or more cardiovascular risk factors. Baseline data on cardiovascular risk factors and associated medication use, and one-year follow-up data on cardiovascular events, hospitalizations, procedures and medication use were collected. Annual hospitalization and medication costs (Canadian dollars) were derived and compared among patients according to the presence of established atherothrombotic disease at baseline, specific arterial beds affected and the number of affected arterial beds. RESULTS Average annualized medication costs were
European Journal of Preventive Cardiology | 2010
John F. Chiu; Alan D. Bell; Robert J. Herman; Michael D. Hill; John A. Stewart; Eric A. Cohen; Chiau-Suong Liau; P. Gabriel Steg; Deepak L. Bhatt; Reach Registry Investigatorsh
1,683,
Canadian Medical Association Journal | 2009
Meyer Balter; Alan D. Bell; Alan Kaplan; Harold Kim; R. Andrew McIvor
1,523 and
Annals of Pharmacotherapy | 2008
Jacques LeLorier; Alan D. Bell; David J. Bougher; Jafna L. Cox; Alexander G.G. Turpie
1,776 for patients with zero, one, and two or three symptomatic arterial beds, respectively. Average annual hospitalization costs increased significantly with the number of beds affected (
Canadian Journal of Cardiology | 2017
Shamir R. Mehta; Kevin R. Bainey; Warren J. Cantor; Marie Lordkipanidzé; Guillaume Marquis-Gravel; Simon D. Robinson; Matthew Sibbald; Derek So; Graham C. Wong; Joseph Abunassar; Margaret L. Ackman; Alan D. Bell; R. Cartier; James D. Douketis; Patrick R. Lawler; Michael Sean McMurtry; Jacob A. Udell; Sean van Diepen; Subodh Verma; G.B. John Mancini; John A. Cairns; Jean-François Tanguay; Paul W. Armstrong; Akshay Bagai; Claudia Bucci; Jean-Pierre Déry; Jean Diodati; Jocelyn Dupuis; David Fitchett; Michael P. Love
380,