Αντιαιμοπεταλιακη αγωγη (ποια, πο τε και για πο σο)
|
|
|
- Rosalyn Long
- 6 years ago
- Views:
Transcription
1 Αντιαιμοπεταλιακη αγωγη (ποια, πο τε και για πο σο) Dimitrios Alexopoulos, MD, FESC, FACC Cardiology Department, Patras University Hospital, Patras, Rio, Greece. Patras University Hospital
2 I, Dimitrios Alexopoulos, have received honoraria for lecturing and research grants from: Astra Zeneca Patras University Hospital
3
4
5
6
7
8
9
10 P2Y12 inhibitors mechanism of action Prasugrel
11 Ticagrelor P2Y 12 Interaction ticagrelor binds to area distinct from ADP receptor site ADP binds to but does not activate receptor Receptor left intact upon dissociation
12
13
14
15
16
17
18 Mega, JAMA Nov 2010 Patras University Hospital
19
20
21
22
23
24
25
26
27
28
29 Study Design Day 0 Visit 1 Day 15 Visit 2 Day 30 NonSTEACS, PCI treated patient Eligible for the study Baseline LAD CBFV adequately recorded Informed consent R Ticagrelor 90mg bid Prasugrel 10mg od Ticagrelor 90mg bid Prasugrel 10 mg od Study procedure at Visit 1 and 2 10 min Resting Period Compliance with treatment assessment MACES, adverse events and bleeding events documentation BP, HR LAD bcbfv Patras University Hospital 5min Recovery periods between the infusions Adverse events monitoring throughout the procedure
30 An example of transthoracic Doppler echocardiography images in a single patient LAD baseline (A) and maximal at 110μg/kg/min adenosine infusion rate (B) CBFV recorded at Day 15 while under prasugrel. Same patient s images of baseline (C) and maximal at 110μg/kg/min adenosine infusion rate CBFV (D) on Day 30, while under ticagrelor. The respective ratios of maximalcbfv/baseline CBFV are shown (B, D). Alexopoulos et al, Circ Cardiovasc Interv 2013, Jun 4. [Epub ahead of print]
31 AUC of LAD maxcbfv at gradually increasing doses of adenosine. Alexopoulos et al, Circ Cardiovasc Interv 2013 Jun 4. [Epub ahead of print]
32
33
34
35 PLATO intent for non-invasive management: Primary composite endpoint CV death, MI or stroke (%) Initially intended for non-invasive management Ticagrelor (n=2601) Clopidogrel (n=2615) p for interaction = 0.89 HR (95% CI) = 0.85( ); p=0.045 Days after randomisation James S, et al. BMJ 2011;342:d3527. Initially intended for invasive management Ticagrelor (n=6732) Clopidogrel (n=6676) HR (95% CI) = 0.84( ) Primary endpoint benefit with ticagrelor was consistent with the overall PLATO trial results 14.3% 12.0% 10.7% 9.0%
36
37
38
39 Alexopoulos D et al, JACCIntv 2011,4:403
40 Ticagrelor vs prasugrel in acute coronary syndrome patients with high on-clopidogrel platelet reactivity following PCI Alexopoulos D, et al. JACC 2012;60:193
41 Randomized assessment of ticagrelor versus prasugrel antiplatelet effects in patients with diabetes mellitus Alexopoulos D et al. Diabetes Care 2013, in press
42 JACC Intv 2012;5:268
43
44
45 Circ Cardiovasc Interv 2012; 5:
46 Randomized assessment of ticagrelor versus prasugrel antiplatelet effects in patients with ST elevation myocardial infarction. Alexopoulos D et al. Circ Cardiovasc Interv. 2012;5:797
47 . Patras University Hospital
48
49
50 Death/ MI/ IDR/ Stent Thrombosis within 48 Hours Event Rate (%) clopidogrel 5.9% cangrelor 4.7% Log Rank P Value = Hours from Randomization Patient at Risk Cangrelor: Clopidogrel: Bhatt DL, Stone GW, Mahaffey KW, et al. Harrington RA. NEJM 2013 at
51
52
53
54
55 Antiplatelet Therapy I IIa IIb III See recommendation for LOE Modified 2012 Patients with definite UA/NSTEMI at medium or high risk and in whom an initial invasive strategy is selected should receive dual antiplatelet therapy on presentation. (Level of Evidence: A) Aspirin should be initiated on presentation. (Level of Evidence: A) The choice of a second antiplatelet therapy to be added to aspirin on presentation includes 1 of the following (note that there are no data for therapy with 2 concurrent P2Y 12 receptor inhibitors, and this is not recommended in the case of aspirin allergy): Before PCI: Clopidogrel (Level of Evidence: B); or Ticagrelor (Level of Evidence: B); or An IV GP IIb/IIIa inhibitor. (Level of Evidence: A) IV eptifibatide and tirofiban are the preferred GP IIb/IIIa inhibitors. (Level of Evidence: B) At the time of PCI: Clopidogrel if not started before PCI (Level of Evidence: A); or Prasugrel (Level of Evidence: B); or Ticagrelor (Level of Evidence: B); or An IV GP IIb/IIIa inhibitor. (Level of Evidence: A) Patras University Hospital
56 Additional Management Considerations for Antiplatelet and Anticoagulant Therapy I IIa New 2012 IIb III Platelet function testing to determine platelet inhibitory response in patients with UA/NSTEMI (or, after ACS and PCI) on P2Y 12 receptor inhibitor therapy may be considered if results of testing may alter management. I IIa New 2012 IIb III Genotyping for a CYP2C19 loss of function variant in patients with UA/NSTEMI (or, after ACS and with PCI) on P2Y 12 receptor inhibitor therapy might be considered if results of testing may alter management ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management Patras University Hospital of Patients With Unstable Angina/ Non ST-Elevation Myocardial Infarction 56
57
58
59
60 Declining stent thrombosis rate Better implantation techniques Stronger platelet inhibition Stable patients Newer stents Patras University Hospital
61
62 Long term antiplatelet therapy Evidence for long term DAPT Prevention of stent thrombosis DAPT and bleeding complications Risks of DAPT discontinuation Triple therapy Special situations Patras University Hospital
63
64 Individualize duration of DAPT in patients at increased bleeding risk Previous stroke/tia Elderly (>75 years) Low body weight (< 60 kg) History of previous bleeding Female gender Renal failure Patras University Hospital
65 Long term antiplatelet therapy of the NSTEMI patient Evidence for long term DAPT Prevention of stent thrombosis DAPT and bleeding complications Risks of DAPT discontinuation Triple therapy Special situations Patras University Hospital
66
67
68 Triple antithrombotic therapy ESC/EACTS GUIDELINES 2011 Should only be given if a compelling indication exists (AF with CHADS score 2, mechanical valves, recent/recurrent Hx of deep venous thrombosis, PE) Only for the shortest period with frequent INR measurement (Target 2-2.5) Avoid DES (to restrict the duration to 1 month) Patras University Hospital
69
70
71
72 When to stop? DAPT should be given for 1 year following ACS Longer duration for high ishaemic risk Shorter duration for high risk of bleeding ST rate is declining due to better stents, more efficient platelet inhibition Cessation of DAPT is a major risk factor for ST in the first 6 months Patras University Hospital
73 When to stop? Triple therapy may be needed / particular caution To maximize the effectiveness of therapy and reduce the hazard of bleeding, ischaemic and bleeding risks should be evaluated on an individual basis. Patras University Hospital
74
75 2701 patients free of MACCE with DAPT at 12 months post DES randomized to clop + ASA vs ASA Patras University Hospital Park, NEJM 2010
76
77
78
79
80 TIMI major non-cabg related bleeding p= %* p= %* K-M estimated rate p= %* Patras University Hospital Silvain J. and Montalescot G. Circ Card Interv 2011
81 No link between clopidogrel withdrawal and ST > 6 months
82 Predictors of early discontinuation Renal impairment, prior major haemorrage, PAD Anticoagulant therapy, private hospital, no instructions Immigrants, psychotropic drugs In-hospital major bleeding Oral anticoagulation at discharge No statin prescription Patras University Hospital Ferreira-Gonzalez, Circ 2010, Rossini, AJC 2011
83 Recurrent stent thrombosis Prasugrel lifelong If contra? Ticagrelor? double clopidogrel? Patras University Hospital Kimura, RESTART Circ 2010
84
85
86
87
88 Antiplatelet Therapy I IIa IIb III See recommendation for LOE Modified 2012 For UA/NSTEMI patients in whom an initial conservative strategy is selected, if recurrent symptoms/ischemia, heart failure, or serious arrhythmias subsequently appear, then diagnostic angiography should be performed. (Level of Evidence: A) Either an IV GP IIb/IIIa inhibitor (eptifibatide or tirofiban [Level of Evidence: A]), clopidogrel(loading dose followed by daily maintenance dose [Level of Evidence: B]), or ticagrelor (loading dose followed by daily maintenance dose [Level of Evidence: B]) should be added to aspirin and anticoagulant therapy before diagnostic angiography (upstream). (Level of Evidence: C) Patras University Hospital
89 Antiplatelet Therapy I IIa IIb III See recommendation for LOE Modified 2012 A loading dose of P2Y 12 receptor inhibitor therapy is recommended for UA/NSTEMI patients for whom PCI is planned. One of the following regimens should be used: a. Clopidogrel 600 mg should be given as early as possible before or at the time of PCI (Level of Evidence: B) or b. Prasugrel 60 mg should be given promptly and no later than 1 hour after PCI once coronary anatomy is defined and a decision is made to proceed with PCI (Level of Evidence: B) or c. Ticagrelor 180 mg should be given as early as possible before or at the time of PCI. (Level of Evidence: B) Patras University Hospital
90
91
92
93
94
95 Alexopoulos et al, Circ Cardiovasc Interv 2013, Jun 4. [Epub ahead of print] Patras University Hospital
96 JACC 2013;61:1601
97
98 Alexopoulos et al, JACC 2013, in press
99 INFUSE-AMI Trial 452 pts with anterior STEMI Anticipated Sx x to PCI <5 hrs, TIMI flow in prox or mid LAD Primary PCI with bivalirudin anticoagulation Pre-loaded with aspirin and clopidogrel 600 mg or prasugrel 60 mg Manual aspiration R 1:1 Stratified by symptoms to angio <3 vs 3 3 hrs, and prox vs mid LAD occlusion No aspiration R 1:1 R 1:1 IC Abcx No Abcx IC Abcx No Abcx Primary endpoint: Infarct size at 30 days (cmri) 2º endpoints: TIMI flow, blush, ST-resolution, MACE (30d, 1 yr) Patras University Hospital
100 INFUSE-AMI: Infarct size at 30 days* Median [IQR] 15.1% [6.8, 22.7] Median [IQR] 17.9% [10.3, 25.4] Infarct size, %LV P=0.03 IC abciximab N=229 No abciximab N=223 Patras University Hospital *Core laboratory assessed
101
102 Individualize duration of DAPT in patients at increased risk for ST End-stage renal disease/hd CTO Age <65 Prior PCI IDDM Heart failure Low body weight Patras University Hospital Kimura, RESTART Circ 2010
103 Bellemain-Appaix JACC 2010
Πποβλημαηιζμοί με ηην ανηιαιμοπεηαλιακή αγωγή ζηο οξύ έμθπαγμα ηος μςοκαπδίος με ανάζπαζη ηος διαζηήμαηορ ST.
Patras University Hospital Πποβλημαηιζμοί με ηην ανηιαιμοπεηαλιακή αγωγή ζηο οξύ έμθπαγμα ηος μςοκαπδίος με ανάζπαζη ηος διαζηήμαηορ ST. Dimitrios Alexopoulos, MD, FACC, FESC Cardiology Department, Patras
Stephan Windecker Department of Cardiology Swiss Cardiovascular Center and Clinical Trials Unit Bern Bern University Hospital, Switzerland
Advances in Antiplatelet Therapy in PCI and ACS Stephan Windecker Department of Cardiology Swiss Cardiovascular Center and Clinical Trials Unit Bern Bern University Hospital, Switzerland Targets for Platelet
Surveying the Landscape of Oral Antiplatelet Therapy in Acute Coronary Syndrome Management
Surveying the Landscape of Oral Antiplatelet Therapy in Acute Coronary Syndrome Management Jeffrey S Berger, MD, MS Assistant Professor of Medicine and Surgery Director of Cardiovascular Thrombosis Disclosures
Adjunctive Antithrombotic for PCI. SCAI Fellows Course December 9, 2013
Adjunctive Antithrombotic for PCI SCAI Fellows Course December 9, 2013 Theodore A Bass, MD FSCAI President SCAI Professor of Medicine, University of Florida Medical Director UF Shands CV Center,Jacksonville
Νεώτερα στην αντιαιμοπεταλιακή αγωγή
Patras University Hospital Νεώτερα στην αντιαιμοπεταλιακή αγωγή Δημήτριος Αλεξόπουλος MD, FESC, FACC Καθηγητής Καρδιολογίας Παν/μίου Πατρών ΟΕ 2014 Patras University Hospital I, Dimitrios Alexopoulos,
Disclosures. Theodore A. Bass MD, FSCAI. The following relationships exist related to this presentation. None
SCAI Fellows Course December 10, 2013 Disclosures Theodore A. Bass MD, FSCAI The following relationships exist related to this presentation None Current Controversies on DAPT in PCI Which drug? When to
Learning Objectives. Epidemiology of Acute Coronary Syndrome
Cardiovascular Update: Antiplatelet therapy in acute coronary syndromes PHILLIP WEEKS, PHARM.D., BCPS-AQ CARDIOLOGY Learning Objectives Interpret guidelines as they relate to constructing an antiplatelet
Optimal antiplatelet and anticoagulant therapy for patients treated in STEMI network
Torino 6 Joint meeting with Mayo Clinic Great Innovation in Cardiology 14-15 Ottobre 2010 Optimal antiplatelet and anticoagulant therapy for patients treated in STEMI network Diego Ardissino Ischemic vs
Updated and Guideline Based Treatment of Patients with STEMI
Updated and Guideline Based Treatment of Patients with STEMI Eli I. Lev, MD Director, Cardiac Catheterization Laboratory Hasharon Hospital, Rabin Medical Center Associate Professor of Cardiology Tel-Aviv
Cangrelor: Is it the new CHAMPION for PCI? Robert Barcelona, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Intensive Care Unit November 13, 2015
Cangrelor: Is it the new CHAMPION for PCI? Robert Barcelona, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Intensive Care Unit November 13, 2015 Objectives Review the pharmacology and pharmacokinetic
Διάρκεια διπλής αντιαιμοπεταλιακής αγωγής. Νικόλαος Γ.Πατσουράκος Καρδιολόγος, Επιμελητής Α ΕΣΥ Τζάνειο Γενικό Νοσοκομείο Πειραιά
Διάρκεια διπλής αντιαιμοπεταλιακής αγωγής Νικόλαος Γ.Πατσουράκος Καρδιολόγος, Επιμελητής Α ΕΣΥ Τζάνειο Γενικό Νοσοκομείο Πειραιά International ACS guidelines: Recommendations on duration of dual
Oral anticoagulation/antiplatelet therapy in the secondary prevention of ACS patients the cost of reducing death!
Oral anticoagulation/antiplatelet therapy in the secondary prevention of ACS patients the cost of reducing death! Robert C. Welsh, MD, FRCPC Associate Professor of Medicine Director, Adult Cardiac Catheterization
DECLARATION OF CONFLICT OF INTEREST. Lecture fees: AstraZeneca, Ely Lilly, Merck.
DECLARATION OF CONFLICT OF INTEREST Lecture fees: AstraZeneca, Ely Lilly, Merck. Risk of stopping dual therapy. S D Kristensen, FESC Aarhus Denmark Acute coronary syndrome: coronary thrombus Platelets
Management of Patients with Atrial Fibrillation and Stents: Is Three Drugs Too Many?
Management of Patients with Atrial Fibrillation and Stents: Is Three Drugs Too Many? Neal S. Kleiman, MD Houston Methodist DeBakey Heart and Vascular Center, Houston, TX Some Things Are Really Clear 2013
Timing of Surgery After Percutaneous Coronary Intervention
Timing of Surgery After Percutaneous Coronary Intervention Deepak Talreja, MD, FACC Bayview/EVMS/Sentara Outline/Highlights Timing of elective surgery What to do with medications Stopping anti-platelet
Dual Antiplatelet Therapy Made Practical
Dual Antiplatelet Therapy Made Practical David Parra, Pharm.D., FCCP, BCPS Clinical Pharmacy Program Manager in Cardiology/Anticoagulation VISN 8 Pharmacy Benefits Management Clinical Associate Professor
Optimal Duration of Dual Anti- Platelet Therapy. December 19, 2015
Optimal Duration of Dual Anti- Platelet Therapy December 19, 2015 John S. MacGregor, M.D., Ph.D. Professor of Medicine University of California San Francisco Source: The New Yorker 1 Optimal Duration of
Acute Coronary Syndrome. Cindy Baker, MD FACC Director Peripheral Vascular Interventions Division of Cardiovascular Medicine
Acute Coronary Syndrome Cindy Baker, MD FACC Director Peripheral Vascular Interventions Division of Cardiovascular Medicine Topics Timing is everything So many drugs to choose from What s a MINOCA? 2 Acute
Belinda Green, Cardiologist, SDHB, 2016
Acute Coronary syndromes All STEMI ALL Non STEMI Unstable angina Belinda Green, Cardiologist, SDHB, 2016 Thrombus in proximal LAD Underlying pathophysiology Be very afraid for your patient Wellens
Optimal Duration and Dose of Antiplatelet Therapy after PCI
Optimal Duration and Dose of Antiplatelet Therapy after PCI Donghoon Choi, MD, PhD Severance Cardiovascular Center Yonsei University College of Medicine Optimal Duration of Antiplatelet Therapy after PCI
An Update on Oral Anti-platelet therapy in patients with non-st Myocardial Infarction. Disclosures
An Update on Oral Anti-platelet therapy in patients with non-st Myocardial Infarction R. Scott Wright, MD, FACC, FESC, FAHA, Professor of Medicine Mayo Clinic Fall Managed Care Forum November 2013 3098590-1
Is Cangrelor hype or hope in STEMI primary PCI?
Is Cangrelor hype or hope in STEMI primary PCI? ARUN KALYANASUNDARAM MD, MPH, FSCAI HOPE Issues with platelet inhibition in STEMI Delayed onset In acute settings, achieving the expected antiplatelet effect
What oral antiplatelet therapy would you choose? a) ASA alone b) ASA + Clopidogrel c) ASA + Prasugrel d) ASA + Ticagrelor
76 year old female Prior Hypertension, Hyperlipidemia, Smoking On Hydrochlorothiazide, Atorvastatin New onset chest discomfort; 2 episodes in past 24 hours Heart rate 122/min; BP 170/92 mm Hg, Killip Class
Novel Anticoagulation Therapy in Acute Coronary Syndrome
Novel Anticoagulation Therapy in Acute Coronary Syndrome Soon Jun Hong Korea University Anam Hospital 1 Thrombus Formation Cascade Coagulation Cascade Platelet Cascade TXA2 Aspirin R Inhibitor Fondaparinux
Guideline for STEMI. Reperfusion at a PCI-Capable Hospital
MANSOURA. 2015 Guideline for STEMI Reperfusion at a PCI-Capable Hospital Mahmoud Yossof MANSOURA 2015 Reperfusion Therapy for Patients with STEMI *Patients with cardiogenic shock or severe heart failure
3/23/2017. Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate Europace Oct;14(10): Epub 2012 Aug 24.
Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate 2017 Explain the efficacy and safety of triple therapy, in regards to thromboembolic and bleeding risk Summarize the guideline recommendations
Prasugrel vs. Ticagrelor in ACS/PCI Which one to choose? V. Voudris MD FESC FACC 2 nd Cardiology Division Onassis Cardiac Surgery Center
Prasugrel vs. Ticagrelor in ACS/PCI Which one to choose? V. Voudris MD FESC FACC 2 nd Cardiology Division Onassis Cardiac Surgery Center Hospitalizations in the U.S. Due to ACS Acute Coronary Syndromes
Clopidogrel vs New Antiplatelet Therapy (Prasugrel) Adnan Kastrati, MD Deutsches Herzzentrum, Technische Universität München, Germany
Clopidogrel vs New Antiplatelet Therapy () Adnan Kastrati, MD Deutsches Herzzentrum, Technische Universität München, Germany Seoul, April 3, 21 Dual Antiplatelet Therapy for Stenting MACE, % 12 1 8 6 In
Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate 2017
Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate 2017 Explain the efficacy and safety of triple therapy, in regards to thromboembolic and bleeding risk Summarize the guideline recommendations
COME ORIENTARSI TRA I NUOVI. Maria Rosa Conte H. Mauriziano Torino
COME ORIENTARSI TRA I NUOVI ANTIPIASTRINIC I Maria Rosa Conte H. Mauriziano Torino Sulle sponde del Ticino- Novara 10 maggio 2013 NEW ORAL ANTIPLATET AGENT PRASUGREL TICAGRELOR (Cangrelor) Death/ MI/
Why and How Should We Switch Clopidogrel to Prasugrel?
Case Presentation Why and How Should We Switch Clopidogrel to Prasugrel? Shaul Atar Western Galilee Medical Center Nahariya, ISRAEL Case Description A 67 Y. Old Pt. admitted to IM with anginal CP. DM,
Adjunctive Antithrombotic for PCI. SCAI Fellows Course December 8, 2014
Adjunctive Antithrombotic for PCI SCAI Fellows Course December 8, 2014 Theodore A Bass, MD FSCAI Immediate Past-President SCAI Professor of Medicine, University of Florida Medical Director UF Health CV
Acute Coronary Syndromes
Overview Acute Coronary Syndromes Rabeea Aboufakher, MD, FACC, FSCAI Section Chief of Cardiology Altru Health System Grand Forks, ND Epidemiology Pathophysiology Clinical features and diagnosis STEMI management
Improving Patient Outcomes: Updated Treatment Strategies in the Management of Acute Coronary Syndrome
Improving Patient Outcomes: Updated Treatment Strategies in the Management of Acute Coronary Syndrome E. Magnus Ohman, MB, FRCPI, FESC, FACC Professor of Cardiovascular Medicine The Kent and Siri Rawson
Oral Antiplatelet Therapy in Patients with ACS: A Focus on Prasugrel and Ticagrelor
Oral Antiplatelet Therapy in Patients with ACS: A Focus on Prasugrel and Ticagrelor Nicolas W. Shammas, MS, MD, FACC Coronary and Peripheral Interventionalist Cardiovascular Medicine, PC Research Director,
Tailoring adjunctive antithrombotic therapy to reperfusion strategy in STEMI
Tailoring adjunctive antithrombotic therapy to reperfusion strategy in STEMI Adel El-Etriby; MD Professor of Cardiology Ain Shams University President of the Egyptian Working Group of Interventional Cardiology
Στεφανιαίος ασθενής με μη βαλβιδική Κολπική Μαρμαρυγή - Νέες στρατηγικές
4 ο ΠΑΝΕΛΛΗΝΙΟ ΑΡΡΥΘΜΙΟΛΟΓΙΚΟ ΣΥΝΕΔΡΙΟ 21-22 ΣΕΠΤΕΜΒΡΙΟΥ 2018 HILTON, ΑΘΗΝΑ Στεφανιαίος ασθενής με μη βαλβιδική Κολπική Μαρμαρυγή - Νέες στρατηγικές Ι. Κανακάκης MD, PhD Διευθυντής Αιμοδυναμικού Τμήματος
Platelet function testing to guide P2Y 12 -inhibitor treatment in ACS patients after PCI: insights from a national program in Hungary
Platelet function testing to guide P2Y 12 -inhibitor treatment in ACS patients after PCI: insights from a national program in Hungary Dániel Aradi MD PhD Interventional Cardiologist Assistant professor
When and how to combine antiplatelet agents and anticoagulant?
When and how to combine antiplatelet agents and anticoagulant? Christophe Beauloye, MD, PhD Head, Division of Cardiology Cliniques Universitaires Saint-Luc Brussels, Belgium Introduction Anticoagulation
Which drug do you prefer for stable CAD? - P2Y12 inhibitor
Which drug do you prefer for stable CAD? - P2Y12 inhibitor Jung Rae Cho, MD, PhD Cardiovascular Division, Department of Internal Medicine Kangnam Sacred Heart Hospital, Hallym University Medical Center,
Asif Serajian DO FACC FSCAI
Anticoagulation and Antiplatelet update: A case based approach Asif Serajian DO FACC FSCAI No disclosures relevant to this talk Objectives 1. Discuss the indication for antiplatelet therapy for cardiac
SCA ST- : recommandations européennes 2015 La durée de la bithérapie : à géométrie variable?
SCA ST- : recommandations européennes 2015 La durée de la bithérapie : à géométrie variable? tielle est 2 ré Totielle est interdite. Prof. Marco Roffi Hôpitaux Universitaires de Genève Research funding
Optimal lenght of DAPT in different clinical scenarios
Optimal lenght of DAPT in different clinical scenarios After PCI with DES in the light of recent and ongoing studies Dr Grégoire Rangé / CH Chartres / France DAPT duration depend on the evolution of risk
Προβληματισμοι στην χρηση αντιαιμοπεταλιακων στα οξέα ισχαιμικά σύνδρομα
Α ΚΑΡΔΙΟΛΟΓΙΚΗ ΚΛΙΝΙΚΗ ΚΑΙ ΟΜΩΝΥΜΟ ΕΡΓΑΣΤΗΡΙΟ ΙΑΤΡΙΚΗ ΣΧΟΛΗ ΠΑΝΕΠΙΣΤΗΜΙΟΥ ΑΘΗΝΩΝ ΙΠΠΟΚΡΑΤΕΙΟ ΓΕΝΙΚΟ ΝΟΣΟΚΟΜΕΙΟ ΑΘΗΝΩΝ Διευθυντής: Καθηγητής ΔΗΜΗΤΡΙΟΣ ΤΟΥΣΟΥΛΗΣ Προβληματισμοι στην χρηση αντιαιμοπεταλιακων
The Challenge. Warfarin or Novel Oral Anti-Coagulants in the PCI patient? Anticoagulation/Stroke
Anticoagulation/Stroke Warfarin v new oral anticoagulants post PCI Warfarin or Novel Oral Anti-Coagulants in the PCI patient? Gerry Devlin Chairs: Phillip Matsis & Tony Scott Gerry Devlin Honorary Associate
P2Y 12 blockade. To load or not to load before the cath lab?
UPDATE ON ANTITHROMBOTICS IN ACUTE CORONARY SYNDROMES P2Y 12 blockade. To load or not to load before the cath lab? Franz-Josef Neumann Personal: None Institutional: Conflict of Interest Speaker honoraria,
Optimal antithrombotic therapy:
Optimal antithrombotic therapy: upstream and during primary PCI. Steen D Kristensen, MD, DMSc, FESC Professor and Consultant Interventional Cardiologist Aarhus University, Denmark UNIVERSITY OF AARHUS
Quale terapia antiaggregante nello STEMI? Prasugrel vs ticagrelor
Quale terapia antiaggregante nello STEMI? Prasugrel vs ticagrelor Leonardo Bolognese Cardiovascular Department, Arezzo, Italy Platelet Reactivity in Patients with STEMI Undergoing Primary PCI Campo G et
(ClinicalTrials.gov ID: NCT ) Title: The Italian Elderly ACS Study Author: Stefano Savonitto. Date: 29 August 2011 Meeting: ESC congress, Paris
Early aggressive versus initially conservative strategy in elderly patients with non-st- elevation acute coronary syndrome: the Italian randomised trial (ClinicalTrials.gov ID: NCT00510185) Stefano Savonitto,
Stable CAD, Elective Stenting and AFib
Stable CAD, Elective Stenting and AFib Kurt Huber, MD, FESC, FACC, FAHA 3 rd Medical Department Cardiology & Intensive Care Medicine Wilhelminenhospital & Sigmund Freud Private University, Medical School
OUTPATIENT ANTITHROMBOTIC MANAGEMENT POST NON-ST ELEVATION ACUTE CORONARY SYNDROME. TARGET AUDIENCE: All Canadian health care professionals.
OUTPATIENT ANTITHROMBOTIC MANAGEMENT POST NON-ST ELEVATION ACUTE CORONARY SYNDROME TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To review the use of antiplatelet agents and oral
What is new in the Treatment of STEMI? Malcolm R. Bell, MBBS Mayo Clinic Rochester, MN
What is new in the Treatment of STEMI? Malcolm R. Bell, MBBS Mayo Clinic Rochester, MN October 2011 Part 2 Summary of newer antithrombotic and antiplatelet agents in STEMI Role of thrombectomy in PPCI
GRAND ROUNDS - DILEMMAS IN ANTICOAGULATION AND ANTIPLATELET THERAPY. Nick Collins February 2017
GRAND ROUNDS - DILEMMAS IN ANTICOAGULATION AND ANTIPLATELET THERAPY Nick Collins February 2017 DISCLOSURES Before I commence Acknowledge.. Interventional Cardiologist Perception evolved. Interventional
TRIAL UPDATE 1. ISAR TRIPLE SECURITY Trial. Dr Deven Patel Royal Free Hospital
TRIAL UPDATE 1 ISAR TRIPLE SECURITY Trial Dr Deven Patel Royal Free Hospital NO CONFLICT OF INTEREST TO DECLARE ISAR TRIPLE Comparison of 6 weeks vs 6 months Triple Therapy in patients on oral anticoagulation
Switching antiplatelet regimens: alternatives to clopidogrel in STEMI patients
Patras University Hospital Switching antiplatelet regimens: alternatives to clopidogrel in STEMI patients Dimitrios Alexopoulos, MD, FESC, FACC Professor of Cardiology Patras University Hospital Greece
STEMI update. Vijay Krishnamoorthy M.D. Interventional Cardiology
STEMI update Vijay Krishnamoorthy M.D. Interventional Cardiology OVERVIEW Current Standard of Care in Management of STEMI Update in management of STEMI Pre-Cath Lab In the ED/Office/EMS. Cath Lab Post
Antiplatelet Therapy: how, why, when? For Coronary Stenting
Antiplatelet Therapy: how, why, when? For Coronary Stenting Dominick J. Angiolillo, MD, PhD, FACC, FESC, FSCAI Director of Cardiovascular Research Associate Professor of Medicine University of Florida
Low Dose Rivaroxaban Versus Aspirin, in Addition to P2Y12 Inhibition, in Acute Coronary Syndromes (GEMINI-ACS-1)
Low Dose Rivaroxaban Versus Aspirin, in Addition to P2Y12 Inhibition, in Acute Coronary Syndromes (GEMINI-ACS-1) Caitlin C. Akerman, PharmD PGY2 Cardiology Resident WakeMed Health & Hospitals Raleigh,
TRIPLE THERAPY, NOACs with concurrent indication for DAPT. Paul Wright Lead Cardiac Pharmacist The Heart, UCLH NHS Foundation Trust
TRIPLE THERAPY, NOACs with concurrent indication for DAPT Paul Wright Lead Cardiac Pharmacist The Heart, UCLH NHS Foundation Trust Content Why consider triple therapy What we know of triple therapy Current
M/39 CC D. => peak CKMB (12 hr later) ng/ml T.chol/TG/HDL/LDL 180/150/48/102 mg/dl #
Acute Coronary Syndrome - Case Review - Young-Guk Ko, MD Yonsei Cardiovascular Center Yonsei University College of Medicine Case 1 M/39 #4306212 CC D : Severe squeezing chest pain : 4 hours, aggravated
Disclosures. Research consulting with: Sanofi-Regeneron Pfizer The Medicines Company Astra Zeneca
Antiplatelet Therapy in Coronary Artery Disease -2015 What are the roles for newer therapies? How do you decide what to cover? R. Scott Wright, MD, FACC, FESC, FAHA Professor of Medicine, Mayo Clinic College
Update on Antithrombotic Therapy in Acute Coronary Syndrome
Update on Antithrombotic Therapy in Acute Coronary Syndrome Laura Tsang November 13, 2006 Objectives: By the end of this session, you should understand: The role of antithrombotics in ACS Their mechanisms
Tim Henry, MD Director, Division of Cardiology Professor, Department of Medicine Cedars-Sinai Heart Institute
Tim Henry, MD Director, Division of Cardiology Professor, Department of Medicine Cedars-Sinai Heart Institute Implications of Pre-loading on Patients Undergoing Coronary Angiography Angiography Define
Selective use of platelet glycoprotein IIb/IIIa inhibition
20 years clinical use of GP IIb/IIIa receptor antagonists: What have we learned and where to go? EBAC ACCREDITED EDUCATIONAL PROGRAMME HELD DURING THE ESC CONGRESS 2014 Selective use of platelet glycoprotein
Ticagrelor compared with clopidogrel in patients with acute coronary syndromes the PLATO trial
compared with clopidogrel in patients with acute coronary syndromes the PLATO trial August 30, 2009 at 08.00 CET PLATO background In NSTE-ACS and STEMI, current guidelines recommend 12 months aspirin and
Timing of Anti-Platelet Therapy for ACS (EARLY-ACS & ACUITY) Mitchell W. Krucoff, MD, FACC
Timing of Anti-Platelet Therapy for ACS (EARLY-ACS & ACUITY) Mitchell W. Krucoff, MD, FACC Professor, Medicine/Cardiology Duke University Medical Center Director, Cardiovascular Devices Unit Duke Clinical
Bivalirudin should be indicated for all patients with STEMI. Adnan Kastrati Deutsches Herzzentrum, Munich, Germany
Bivalirudin should be indicated for all patients with STEMI Adnan Kastrati Deutsches Herzzentrum, Munich, Germany 1 Heparin+IIb/IIIa, heparin alone or bivalirudin in STEMI: Do we have the answer? 2 Heparin+IIb/IIIa,
Κωνσταντίνος Π. Τούτουζας Επ. Καθηγηηής Καρδιολογίας. A Πανεπιζηημιακή Καρδιολογική Κλινική, Ιπποκράηειο Νοζοκομείο
Κωνσταντίνος Π. Τούτουζας Επ. Καθηγηηής Καρδιολογίας A Πανεπιζηημιακή Καρδιολογική Κλινική, Ιπποκράηειο Νοζοκομείο Europe* 2001 2011 Incident MI 291,100 327,700 US 2001 2011 Incident MI 405,100 485,200
Speaker s name: Thomas Cuisset, MD, PhD
Speaker s name: Thomas Cuisset, MD, PhD X I have the following potential conflicts of interest to report: x Consulting: Daiichi Sankyo, Eli Lilly Employment in industry Stockholder of a healthcare company
New antiplatelets in NSTEMI. Overview: dual anti-platelet oral therapy
Cairo, Egypt 2010 New antiplatelets in NSTEMI Steen D. Kristensen, FESC Department of Cardiology Aarhus University Hospital Skejby Denmark Overview: dual anti-platelet oral therapy Aspirin Clopidogrel
ACCP Cardiology PRN Journal Club
ACCP Cardiology PRN Journal Club 1 Optimising Crossover from Ticagrelor to Clopidogrel in Patients with Acute Coronary Syndrome [CAPITAL OPTI-CROSS] Monique Conway, PharmD, BCPS PGY-2 Cardiology Pharmacy
ΠΑΝΕΠΙΣΤΗΜΙΟ ΙΩΑΝΝΙΝΩΝ. Εξατοµικευµένη αντιαιµοπεταλιακή αγωγή. Ποιο είναι το µέλλον?
ΠΑΝΕΠΙΣΤΗΜΙΟ ΙΩΑΝΝΙΝΩΝ ΕΡΕΥΝΗΤΙΚΟ ΚΕΝΤΡΟ ΑΘΗΡΟΘΡΟΜΒΩΣΗΣ Εξατοµικευµένη αντιαιµοπεταλιακή αγωγή. Ποιο είναι το µέλλον? Αλέξανδρος Δ. Τσελέπης, MD, PhD Καθηγητής Βιοχηµείας - Κλινικής Χηµείας Disclosures
Thrombin Receptor Antagonists and Other New Oral Antiplatelets Drugs
Thrombin Receptor Antagonists and Other New Oral Antiplatelets Drugs David J. Moliterno, MD Professor and Chairman Department of Internal Medicine The University of Kentucky Linda and Jack Gill Heart Institute
Antithrombotic treatment in ACS: what do the guidelines say? Nicolas Danchin, HEGP, Paris France
Antithrombotic treatment in ACS: what do the guidelines say? Nicolas Danchin, HEGP, Paris France Disclosures Research grants: Astra-Zeneca, Merck, Novartis, Pfizer, sanofi-aventis, Servier, The MedCo Fees
Bivalirudin Clinical Trials Update Evidence and Future Perspectives
Bivalirudin Clinical Trials Update Evidence and Future Perspectives Andreas Baumbach Consultant Cardiologist/ hon. Reader in Cardiology Bristol Heart Institute University Hospitals Bristol MY CONFLICTS
A Randomized Trial Evaluating Clinically Significant Bleeding with Low-Dose Rivaroxaban vs Aspirin, in Addition to P2Y12 inhibition, in ACS
A Randomized Trial Evaluating Clinically Significant Bleeding with Low-Dose Rivaroxaban vs Aspirin, in Addition to P2Y12 inhibition, in ACS Magnus Ohman MB, on behalf of the GEMINI-ACS-1 Investigators
The Future of Oral Antiplatelets in PAD and CAD Christopher Paris, MD, FACC, FSCAI
The Future of Oral Antiplatelets in PAD and CAD Christopher Paris, MD, FACC, FSCAI Interventional Cardiologist Cardiovascular Institute of the South Director of Cardiovascular Services St. Charles Parish
Angioplastica coronarica nel paziente anziano ad alto rischio emorragico
Attualità in Cardiologia Aprilia, Enea Hotel 22 ottobre 2011 Angioplastica coronarica nel paziente anziano ad alto rischio emorragico Fabrizio Tomai, MD, FACC, FESC Dept. of Cardiovascular Sciences - Interventional
Oral Antiplatelet Therapy in PCI/ACS. Dominick J. Angiolillo, MD, PhD, FACC, FESC Director of Cardiovascular Research Assistant Professor of Medicine
Oral Antiplatelet Therapy in PCI/ACS Dominick J. Angiolillo, MD, PhD, FACC, FESC Director of Cardiovascular Research Assistant Professor of Medicine Basic Concepts Thrombus Formation Two key elements:
Controversies in Cardiac Pharmacology
Controversies in Cardiac Pharmacology Thomas D. Conley, MD FACC FSCAI Disclosures I have no relevant relationships with commercial interests to disclose. 1 Doc, do I really need to take all these medicines?
LA TERAPIA ANTIAGGREGANTE PER VIA PARENTERALE
LA TERAPIA ATIAGGREGATE PER VIA PARETERALE Sergio Leonardi, MD, MHS, FESC Cardiovascular Clinical Research Center Fondazione IRCCS Policlinico San Matteo Pavia, Italy 28 March 2015 Induno, BG CI-1 Terapia
Is the role of bivalirudin established?
Is the role of bivalirudin established? Rob Henderson Consultant Cardiologist Trent Cardiac Centre Nottingham University Hospitals Conflicts of Interest: None Declarations: Member NICE Unstable Angina
Session Objectives. Clopidogrel Resistance. Clopidogrel (Plavix )
Session Objectives New Antithrombotics and Real Time Genetic Testing: Their Role in the Vascular Patient Margaret C. Fang, MD, MPH Associate Professor of Medicine Division of Hospital Medicine Medical
Acute Coronary Syndromes. January 9, 2013 Chris Chiles M.D. FACC
Acute Coronary Syndromes January 9, 2013 Chris Chiles M.D. FACC Disclosures None- not even a breakfast burrito from a drug company Hospitalizations in the U.S. Due to ACS Acute Coronary Syndromes* 1.57
Drug Eluting Stents Sometimes Fail ESC Stockholm 29 Set 2010 Stent Thrombosis Alaide Chieffo
Drug Eluting Stents Sometimes Fail ESC Stockholm 29 Set 2010 Stent Thrombosis 11.45-12.07 Alaide Chieffo San Raffaele Scientific Institute, Milan, Italy Historical Perspective 25 20 15 10 5 0 Serruys 1991
Razionale ed evidenze scientifiche di Doppia Antiaggregazione Piastrinica a lungo termine nel Paziente con Sindrome Coronarica Acuta
Razionale ed evidenze scientifiche di Doppia Antiaggregazione Piastrinica a lungo termine nel Paziente con Sindrome Coronarica Acuta Giuseppe Musumeci SC Cardiologia Ospedale Santa Croce e Carle Cuneo
PCI in Patients with AF Optimizing Oral Anticoagulation Regimen
PCI in Patients with AF Optimizing Oral Anticoagulation Regimen Walid I. Saliba, MD Director, Atrial Fibrillation Center Heart and Vascular Institute Cleveland Clinic 1 Epidemiology and AF and PCI AF and
תרופות מעכבות טסיות חדשות ד"ר אלי לב מנהל שרות הצנתורים ח השרון מרכז רפואי רבין
תרופות מעכבות טסיות חדשות ד"ר אלי לב מנהל שרות הצנתורים ח השרון בי""י מרכז רפואי רבין 1. Why should clopidogrel be replaced? 2. Prasugrel 3. Ticagrelor 4. Conclusions CURE TRIAL ACS pts 20 % reduction
DECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST How to manage antiplatelet treatment in patients with diabetes in acute coronary syndrome Lars Wallentin Professor of Cardiology, Chief Researcher Cardiovascular Science
Balancing Efficacy and Safety of P2Y12 Inhibitors for ACS Patients
SYP.CLO-A.16.07.01 Balancing Efficacy and Safety of P2Y12 Inhibitors for ACS Patients dr. Hariadi Hariawan, Sp.PD, Sp.JP (K) TOPICS Efficacy Safety Consideration from Currently Available Antiplatelet Agents
Upstream P2Y 12 RB. Stefano Savonitto Divisione di Cardiologia Arcispedale S. Maria Nuova Reggio Emilia
Upstream P2Y 12 RB Stefano Savonitto Divisione di Cardiologia Arcispedale S. Maria Nuova Reggio Emilia Dio può essere dimostrato Le dimostrazioni dell esistenza di Dio IA Dio non può essere dimostrato
Antiplatelet and Anti-Thrombotic Therapy. Ivan Anderson, MD RIHVH Cardiology
Antiplatelet and Anti-Thrombotic Therapy Ivan Anderson, MD RIHVH Cardiology Outline Anti-thrombotic therapy Risk stratification of stroke with atrial fibrillation DVT and PE treatment Pharmacology Anti-platelet
Dimitrios Alexopoulos, MD, FESC, FACC Patras University Hospital, Patras, Rio, Greece. Patras University Hospital
Patras University Hospital Κατευθυντη ριες Οδηγιές της Ευρωπαι κη ς Καρδιολογικη ς Εταιρειάς στην αντιαιμοπεταλιακη θεραπειά γιαοξεάστεφανιαιάσυ νδρομα. Απο τις συστα σεις στην εφαρμογη στην καθ ημε ρα
Dual Antiplatelet Therapy: Time for a Paradigm Shift?
Dual Antiplatelet Therapy: Time for a Paradigm Shift? 5 years after PLATO Experience from the Daily Clinical Practice Hans Rickli Goals with antithrombotic treatment Acute coronary syndrome Risk reduction
New insights in stent thrombosis: Platelet function monitoring. Franz-Josef Neumann Herz-Zentrum Bad Krozingen
New insights in stent thrombosis: Platelet function monitoring Franz-Josef Neumann Herz-Zentrum Bad Krozingen New insights in stent thrombosis: Platelet function monitoring Variability of residual platelet
Columbia University Medical Center Cardiovascular Research Foundation
STEMI and NSTEMI Pharmacology Confusion: How to Choose and Use Antithrombins (Unfractionated and Low Molecular Heparins, Bivalirudin, Fondaparinux) and Antiplatelet Agents (Aspirin, Clopidogrel and Prasugrel)
Acute coronary syndromes A European viewpoint. Felicita Andreotti, MD PhD FESC Catholic University Hospital Cardiovascular Diseases - Rome, IT
Acute coronary syndromes A European viewpoint Felicita Andreotti, MD PhD FESC Catholic University Hospital Cardiovascular Diseases - Rome, IT Potential conflicts of interest In the past 2 years Felicita
Ticagrelor vs prasugrel in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention
DISCLOSURES: NONE Ticagrelor vs prasugrel in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention I. Xanthopoulou, KC. Theodoropoulos, G. Kassimis, V.
Anticoagulants and antiplatelet therapy in the older patient: Choosing wisely
Anticoagulants and antiplatelet therapy in the older patient: Choosing wisely Rajiv Gulati, MD PhD Advances in Cardiac Arrhythmias & Great Innovations in Cardiology Torino, October 2015 2015 MFMER 3477310-1
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease Developed in Collaboration with American Association for Thoracic Surgery, American