Days
|
|
- Geraldine Hart
- 6 years ago
- Views:
Transcription
1 Post ACS Care 2013 Clinical dilemmas Christopher Granger, MD Professor of Medicine
2 Disclosure Research contracts: AstraZeneca, GSK, Merck, Sanofi- Aventis, BMS, Pfizer, The Medicines Company, Medtronic Foundation, and Boehringer Ingelheim Consulting/Honoraria: AstraZeneca, GSK, BMS, Pfizer, Lilly, Novartis, Roche, Boehringer Ingelheim, Johnson and Johnson, The Medicines Company, and Sanofi- Aventis For full listing see ww.dcri.duke.edu/research/coi.jspcoi.jsp
3 High-risk ACS 80 year old woman with history of hypertension, CABG 1986, MI and stents to LAD in 2003, right CEA, TIA, and asthma Increased CP episodes for one week, and continued chest pain in ED. Treated with nitrates, morphine; beta blocker, with immediate wheezing treated with prednisone. BP 126/68, pulse 101, 80 kg, mild CHF Creatinine 1.7 mg/dl dl; TnT 0.27 ng/ml ECG showed 1mm anterolateral ST depression; echo EF 45% GRACE risk score death in-hospital 25% death/mi 6 months 50%
4 Treatment options (in addition to 81 mg aspirin/d) A. Clopidogrel B. Prasugrel C. Ticagrelor A. UFH B. enoxaparin A. Cath <24hrs B. Cath > 24 hrs C. Med therapy
5 Primary Endpoint CV Death, MI, Stroke 15 Prim mary Endp point (% ) 10 5 HR 0.77 P= HR 0.80 P= Clopidogrel Prasugrel 12.1 (781) (643) HR 0.81 ( ) P= NNT= 46 ITT= 13,608 LTFU = 14 (0.1%) Days
6 4 Clopidogrel Prasugrel Bleeding Events Safety Cohort (N=13,457) ICH in Pts w Prior Stroke/TIA (N=518) % Even nts Clop 0 (0) % Pras 6 (2.3)% (P=0.02) 02) 0 TIMI Major Bleeds Life Threatening Nonfatal Fatal ICH ARD 0.6% ARD 0.5% ARD 0.2% ARD 0.3% ARD 0% HR 1.32 P=0.03 NNH=167 HR 1.52 P=0.01 P=0.23 P=0.002 P=0.74
7 Major efficacy endpoints All patients* Ticagrelor (n=9,333) Clopidogrel (n=9,291) HR for (95% CI) p value Primary objective, n (%) CV death + MI + stroke 864 (9.8) 1,014 (11.7) 0.84 ( ) <0.001 Secondary objectives, n (%) Myocardial infarction CV death Stroke 504 (5.8) 593 (6.9) 0.84 ( ) (4.0) 442 (5.1) 0.79 ( ) (1.5) 106 (1.3) 1.17 ( ) 0.22 Total death 399 (4.5) 506 (5.9) 0.78 ( ) <0.001 The percentages are K-M estimates of the rate of the endpoint at 12 months.
8 Is there a role for continued anticoagulation after ACS?
9 Meta-analysis: analysis: Secondary prevention with warfarin and ASA after ACS Rate ratio (95% CI) Death (077 ( ) MI 0.56 ( ) 0.69) Ischaemic stroke 0.46 ( ) 0.77) Major bleeding event (167 3 ( ) Minor bleeding event 2.65 ( ) Warfarin + ASA better Rate ratio ASA better 10 trials; N=5,938 Rothberg MB, et al. Ann Intern Med ;143:
10 PRIMARY EFFICACY ENDPOINT: CV Death / MI / Stroke (%) Incidence umulative I timated Cu Est Placebo Rivaroxaban (both doses) 2 Yr KM Estimate 10.7% 8.9% HR 0.84 ( ) 0.96) mitt p = ITT p = ARR 1.8% NNT = 56 No. at Risk Months After Randomization Placebo Rivaroxaban Mega NEJM 2011 HR and 95% confidence interval estimates from Cox model stratified by thienopyridine use are provided per mitt approach; Stratified log-rank p-values are provided for both mitt and ITT approaches.
11 EFFICACY ENDPOINTS: Very Low Dose 2.5 mg BID 12% ce (%) Estima ated Cumula ative inciden CV Death / MI / Stroke HR 0.84 mitt p=0.020 ITT p=0.007 Cardiovascular Death 5% 5% Placebo HR 0.66 HR 0.68 Rivaroxaban 25mgBID 2.5 NNT = % 9.1% mitt p=0.002 ITT p=0.005 Placebo Rivaroxaban 25mgBID 2.5 NNT = % 2.7% All Cause Death mitt p= ITT p=0.004 Placebo Rivaroxaban 25mgBID 2.5 NNT = Months Months Months 4.5% 2.9% Mega NEJM 2011
12 Considerations for more potent antithrombotics (versus standard dose clopidogrel) Drug CV death, Major MI, stroke Bleeding Death HD Clopidogrel 6% 24% -- Prasugrel (intended PCI) 19% 32% -- Ticagrelor 16% 4% * 22% Rivaroxaban (+ clopid) 16% 350% 22% Other key considerations Each reduced stent thrombosis by 30 to 50% Prasugrel increased fatal bleeding, particularly in high risk group of elderly, prior stroke, low weight Prasugrel data limited to intended PCI; in STEMI, risk benefit for prasugrel more favorable *Ticagrelor increased non-cabg bleeding by 19%
13 80 year old woman with high-risk ACS Cardiac cath day after admission, patent grafts to RCA and LCX; 75% stenosis in stented segment of LAD, received Cypher drug eluting stent t Creatinine increased to 2.2 mg/dl Day 3, developed d atrial fibrillation ill with RVR, some worse dyspnea
14 ACS, DES, plus Afib with CHADS score of 4, CHADS- VASc of 7
15 Treatment options A. Aspirin, clopidogrel, warfarin for one year B. Aspirin, clopdiogrel, warfarin; stop clopidogrel after 3 months C. Aspirin, ticagrelor, warfarin; stop ticagrelor after 3-6 months D. Aspirin and clopidogrel alone, due to high risk of bleeding
16 CHA 2 DS 2 -VASc Assessment of Thromboembolic Risk Annual stroke Score CHF/ LV dysfunction 1 rate, % Hypertension 1 n Age Diabetes mellitus Stroke/TIA/TE Vascular disease 1 Age Sex category (female) 1 Score 0 9 Validated in 1084 NVAF patients not on OAC with known TE status at 1 year in Euro Heart Survey Lip GYH, et al. Chest 2009 Olesen JB et al. BMJ 2011;342:124
17 Lancet 2009; 374:
18 Registry cohort study of all Danish pts surviving first-time time hosp for AF between 1997 and ,854 of 118,606 pts had prescription filled for warfarin, ASA, or clopidogrel after discharge. During follow-up of 3.3 yrs, 13,573 pts (11.4%) had nonfatal or fatal bleeding. Arch Intern Med. 2010;170:
19 ESC 2012 update: AF, ACS, stenting a period of triple therapy is needed (OAC plus aspirin plus clopidogrel), followed by the combination OAC plus single antiplatelet t l t drug and, after one year, management can be with OAC alone in stable patients, where OAC can be adjusted-dose dose VKA therapy or probably a NOAC. Use triple therapy for minimum time (3-6 mo after DES) Use low dose aspirin Be extra careful to avoid high INR Consider PPI
20 How about dropping aspirin, using warfarin plus clopidogrel?
21 WOEST ESC, Hotline III, Munchen, August 28th, 2012 The WOEST Trial: First randomised d trial comparing two regimens with and without aspirin in patients on oral anticoagulant therapy undergoing coronary stenting Willem Dewilde, Tom Oirbans, Freek Verheugt, Johannes Kelder, Bart De Smet, Jean-Paul Herrman, Tom Adriaenssens, Mathias Vrolix, Antonius Heestermans, Marije Vis, Saman Rasoul, Kaioum Sheikjoesoef, Tom Vandendriessche, Carlos Van Mieghem, Kristoff Cornelis, Jeroen Vos, Guus Brueren, Nicolien Breet and Jurriën ten Berg 279 (double) vs 284 (triple) 65% DES with DAPT plus OAC for one year 70% Afib; 28% ACS at baseline The WOEST Trial= What is the Optimal antiplatelet and anticoagulant therapy in patients with oral anticoagulation and coronary StenTing (clinicaltrials.gov NCT )
22 WOEST Primary Endpoint: Total number of TIMI bleeding events Cumulative incid dence of bleeding 50 % Triple therapy group Double therapy group 40 % 30 % 20 % 44.9% 19.5% 10 % p< % HR= %CI[ ] 0.50] Days n at risk:
23 WOEST % Primary Endpoint: Bleeding events TIMI classification p<0.001 p< Double therapy 25 group p< Triple 16.7 therapy 15 group TIMI Minimal 11.2 TIMI Minor p= TIMI Major Any TIMI bleeding
24 WOEST Secondary Endpoint (Death, MI,TVR,, Stroke, ST) 20 % Triple therapy group Double therapy group 17.7% 15 % Cumulative incid dence 10 % 11.3% 5 % p= % HR= %CI[ ] 0.94] Days n at risk:
25 WOEST p= Secondary Endpoint p= p= Double therapy group Triple therapy group p=0.128 p= Death MI TVR Stroke ST MI=any myocardial infarction; TVR= target vessel revascularisation (PCI + CABG); ST= stent thrombosis
26 In absence of AF or need for OAC, how long should you continue clopidogrel after stenting?
27 72 year old woman with diabetes, NSTMI, insurance, treated with everolimus DES to mid LAD with diffuse disease. What is your preferred antiplatelet strategy, in addition to 81 mg aspirin? Drug 1. Clopidogrel 2. Prasugrel 3. Ticagrelol 4. Begin with prasugrel, switch to clopidogrel Duration 1. One year 2. 2 years 3. > 2 years
28 PRODIGY Study Flow Chart Intent-to-stent 1:1:1:1 Balancing Randomization Xience V Taxus Endeavor BMS 2013 patients 75% ACS 2 yr follow-up 30-Days Short DAPT 1:1 1 Endpoint Randomization Prologned DAPT Aspirin Clopidogrel Aspirin Clopidogrel 6 mos 6 Mos * 6 mos 6 mos 12 mos 12 mos 12 mos 18 mos 18 mos 18 mos 24 mos 24 mos *: <6 months clopidogrel was allowed in BMS pts with stable CAD at the time of PCI Circulation. 2012;125: Mos
29 Primary Efficacy and Safety Outcomes with Shorter vs Longer DAPT 24 mo DAPT 6 mo DAPT Overall Death, MI or CVA Type II, III or V BARC bleeding % 1% % 8 P= % 4 P= % HazardRatio:098( ( ) HazardRatio:046( ( ) Circulation. 2012;125:
30 Summary Ticagrelor and prasugrel provide meaningful advantages over clopidogrel Triple therapy is likely of important benefit for patients with coronary stenting and AF with high risk, but also high risk of bleeding Dual antiplatelet therapy may have greater risk than benefit if continued after 6 mo for elective drug eluting stenting and 12 months for ACS More trials defining if aspirin could be dropped with warfarin and P2Y12 antagonist are needed
Antiplatelet Therapy in Patients on Anticoagulation
Antiplatelet Therapy in Patients on Anticoagulation Ziad A Ali MD DPhil Cardiovascular Research Foundation Columbia University New York, Medical NY Center Cardiovascular Research Foundation Disclosure
More informationANTIPLATELET REGIMENS:
ANTIPLATELET REGIMENS: How Long, How Many? John Carter Hemphill, M.D., F.A.C.C. Chattanooga Heart Institute February 10, 2018 I have no financial disclosures. DISCLOSURES: OBJECTIVES Understand current
More informationWOEST ESC, Hotline III, Munchen, August 28th, 2012
ESC, Hotline III, Munchen, August 28th, 2012 The WOEST Trial: First randomised trial comparing two regimens with and without aspirin in patients on oral anticoagulant therapy undergoing coronary stenting
More informationClinical and Economic Value of Rivaroxaban in Coronary Artery Disease
CHRISTOPHER B. GRANGER, MD Professor of Medicine Division of Cardiology, Department of Medicine; Director, Cardiac Care Unit Duke University Medical Center, Durham, NC Clinical and Economic Value of Rivaroxaban
More informationTriple Therapy After PCI in AF: A Quagmire Soon to be Drained
Triple Therapy After PCI in AF: A Quagmire Soon to be Drained Freek W.A. Verheugt Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG) Amsterdam, Netherlands DISCLOSURES FOR FREEK W. A. VERHEUGT
More informationTRIPLE 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
More informationAntithrombotic therapy in the ACS patient with atrial fibrillation
Antithrombotic therapy in the ACS patient with atrial fibrillation Kurt Huber, MD, FESC, FACC, FAHA 3 rd Medical Department Cardiology & Emergency Medicine Wilhelminenhospital Vienna, Austria Great Minds,
More informationOvercoming the Risk-Treatment Paradox in Non-STE ACS: It s Time! Christopher Granger, MD
Overcoming the Risk-Treatment Paradox in Non-STE ACS: It s Time! Christopher Granger, MD Disclosures Research contracts: AstraZeneca, Bayer, Novartis, GSK, Sanofi-Aventis, BMS, Pfizer, The Medicines Company,
More informationPCI 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
More informationManagement 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
More informationDual 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
More informationA Patient with Chest Pain and Atrial Fibrillation
A Patient with Chest Pain and Atrial Fibrillation Kurt Huber, Vienna, Austria Declaration of Interest Lecturing & Consulting Activities: AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi
More informationStable 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
More informationOral 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
More informationNAVIGATING THROMBOSIS AND BLEEDING AT THE INTERSECTION OF ATRIAL FIBRILLATION AND CORONARY STENTING
NAVIGATING THROMBOSIS AND BLEEDING AT THE INTERSECTION OF ATRIAL FIBRILLATION AND CORONARY STENTING Snehal H. Bhatt, Pharm.D., BCPS-AQ Cardiology, FASHP, AACC Associate Professor of Pharmacy Practice MCPHS
More informationWhen 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
More informationWhich 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,
More informationOptimal 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
More informationA Patient Unsuitable for VKA Treatment
Will Apixaban change practice in atrial fibrillation? A Patient Unsuitable for VKA Treatment Professor Yoseph Rozenman The E. Wolfson Medical Center Jerusalem June 2013 Disclosures I have the following
More informationTRIAL 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
More informationThe 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
More information3/23/2017. 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
More informationRobert C. Welsh, MD, FRCPC Professor of Medicine, University of Alberta Zone Clinical Department Head, Cardiac Sciences
Managing Atrial Fibrillation and ACS/PCI Applying New Evidence to Clinical Practice Dual Anti-Thrombotic Therapy in Acute Coronary Syndromes (ACS) and Afib + PCI/ACS Patients Robert C. Welsh, MD, FRCPC
More informationStudy design: multicenter, randomized, open-label trial following a PROBE design
Subgroup Analysis from the RE-DUAL PCI Trial Dual Antithrombotic Therapy with in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention Jonas Oldgren, Philippe Gabriel Steg, Stefan
More informationAngelika 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
More informationChanging Course: Anticoagulation in Secondary Prevention of Cardiovascular Disease Events
Changing Course: Anticoagulation in Secondary Prevention of Cardiovascular Disease Events Deepak L. Bhatt, MD, MPH Executive Director Interventional Cardiovascular Programs Brigham and Women s Hospital
More informationΣτεφανιαίος 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
More informationByeong-Keuk Kim, M.D. Ph D. Division of Cardiology, Severance Cardiovascular Hospital Yonsei University College of Medicine, Seoul, Korea
Byeong-Keuk Kim, M.D. Ph D Division of Cardiology, Severance Cardiovascular Hospital Yonsei University College of Medicine, Seoul, Korea CASE, M/64 C.C; Recently aggravated chest discomfort for 3 days
More informationDr Αντώνιος Στ. Ντάτσιος MSc, MRCP(UK), FESC. Επεμβατικός Καρδιολόγος Επιμελητής Β Γ. Ν. Θ. Παπαγεωργίου
Dr Αντώνιος Στ. Ντάτσιος MSc, MRCP(UK), FESC. Επεμβατικός Καρδιολόγος Επιμελητής Β Γ. Ν. Θ. Παπαγεωργίου Θεσσαλονίκη, 9/2/2018 Disclosures: None Primary efficacy outcome* (%/year) Antiplatelet Therapy
More informationStephan 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
More informationGRAND 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
More informationIndications of Anticoagulants; Which Agent to Use for Your Patient? Marc Carrier MD MSc FRCPC Thrombosis Program Ottawa Hospital Research Institute
Indications of Anticoagulants; Which Agent to Use for Your Patient? Marc Carrier MD MSc FRCPC Thrombosis Program Ottawa Hospital Research Institute Disclosures Research Support/P.I. Employee Leo Pharma
More informationState of the Art in the ACS Atrial Fibrillation Overlap Syndrome
State of the Art in the ACS Atrial Fibrillation Overlap Syndrome C. Michael Gibson, M.S., M.D. Professor of Medicine, Harvard Medical School Chief, Clinical Research, Beth Israel Deaconess CV Division
More informationUPDATES FROM THE 2018 ANTIPLATELET GUIDELINES
UPDATES FROM THE 2018 ANTIPLATELET GUIDELINES Claudia Bucci BScPhm, PharmD Clinical Coordinator, Cardiovascular Diseases Sunnybrook Health Sciences Centre 21st Annual Contemporary Therapeutic Issues in
More informationDisclosures. 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
More informationWhat 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
More informationThe Poor Long-Term Candidate for Warfarin: NOAC or Left Atrial Appendage Closure?
The Poor Long-Term Candidate for Warfarin: NOAC or Left Atrial Appendage Closure? Suneet Mittal, MD, FACC, FHRS Director, Electrophysiology Laboratory Valley Health System Ridgewood, NJ and New York, NY
More informationDual antiplatelet therapy (DAPT) in the era of Novel Oral Anticoagulants (NOACs) SACIS 2015
Dual antiplatelet therapy (DAPT) in the era of Novel Oral Anticoagulants (NOACs) SACIS 2015 Wesam A Alhejily MD FRCPC FACP FACC FSCAI Assistant Professor of Medicine Chief Of Adult Cardiology Consultant
More informationAnticoagulants 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
More informationSpecial Conditions of NOAC PCI 가톨릭의대 순환기내과 장성원
Special Conditions of NOAC PCI 가톨릭의대 순환기내과 장성원 Issues on Patients with NOAC PCI Peri-procedural management CKD or dialysis Cardioversion Neurological situations Dual Antiplatelet Therapy with Oral Anticoagulants
More informationAsif 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
More informationA 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
More informationSurveying 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
More informationSubsequent management and therapies
ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation Subsequent management and therapies Marco Valgimigli, MD, PhD University of Ferrara ITALY
More informationAntithrombotic therapy in CAD patients with concomitant NAFV: why and for whom?
Antithrombotic therapy in CAD patients with concomitant NAFV: why and for whom? Institut de Cardiologie de la Pitié-Salpêtrière jean-philippe.collet@psl.aphp.fr www.action-coeur.org Patients (%) Patients
More informationLow 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,
More informationcontroversies in anticoagulation: optimizing outcome for atrial fibrillation
controversies in anticoagulation: optimizing outcome for atrial fibrillation SUNDAY, NOVEMBER 13, 2016 WESTIN HOTEL NEW ORLEANS CANAL PLACE COLLABORATE INVESTIGATE EDUCATE PROVIDING PERSPECTIVE: CURRENT
More information8th Emirates Cardiac Society Congress in collaboration with ACC Middle East Conference Dubai: October Acute Coronary Syndromes
8th Emirates Cardiac Society Congress in collaboration with ACC Middle East Conference 2017 Dubai: 19-21 October 2017 Acute Coronary Syndromes Antonio Colombo Centro Cuore Columbus and S. Raffaele Scientific
More informationEvents after discontinuation of randomized treatment at the end of the ARISTOTLE trial
Events after discontinuation of randomized treatment at the end of the ARISTOTLE trial Christopher Granger, John Alexander, Michael Hanna, Jerry Wang, Puneet Mohan, Jack Lawrence, Elaine Hylek, Jack Ansell,
More informationPaolo Gresele Dipartimento di Medicina Sezione di Medicina Interna e Cardiovascolare Università di Perugia
Anticoagulanti e mono-antiaggregazione: a chi, quali e per quanto tempo Paolo Gresele Dipartimento di Medicina Sezione di Medicina Interna e Cardiovascolare Università di Perugia Anticoagulazione: Bologna,
More informationThrombin 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
More informationDoes COMPASS Change Practice?
Does COMPASS Change Practice? C. Michael Gibson, M.S., M.D. Professor of Medicine, Harvard Medical School Chief, Clinical Research, Beth Israel Deaconess CV Division Chairman, PERFUSE Study Group Founder,
More informationUsing DOACs in CAD Patients in Sinus Ryhthm Results of the ATLAS ACS 2, COMPASS and COMMANDER-HF Trials
Using DOACs in CAD Patients in Sinus Ryhthm Results of the ATLAS ACS 2, COMPASS and COMMANDER-HF Trials 19 th Annual San Diego Heart Failure Symposium for Primary Care Physicians January 11-12, 2019 La
More informationThe Great debate: thrombocardiology post-compass
The Great debate: thrombocardiology post-compass Anticoagulation should replace antiplatelets in CAD prevention - CON Jean-Philippe COLLET Jean-philippe.collet@psl.aphp.fr Sorbonne Université_Action Study
More informationAcute 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
More informationSCA 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
More informationISCHEMIC HEART DISEASE
ESC CONGRESS HIGHLIGHTS ISCHEMIC HEART DISEASE Francesco Cosentino (Stockholm, S) Declaration of Interest Advisory Board/Speaker: AstraZeneca, Roche, Boehringer-Ingelheim, Bristol-Myers Squibb, Merck,
More informationANTI-THROMBOTIC THERAPY in NON-VALVULAR ATRIAL FIBRILLATION
ANTI-THROMBOTIC THERAPY in NON-VALVULAR ATRIAL FIBRILLATION Colin Edwards Auckland Heart Group Waitemata Health June 2015 PFIZER Lecture series Disclosures EPIDEMIOLOGY Atrial fibrillation is the most
More informationManagement of Patients with Atrial Fibrillation Undergoing Coronary Artery Stenting 경북대의전원내과조용근
Management of Patients with Atrial Fibrillation Undergoing Coronary Artery Stenting 경북대의전원내과조용근 Case (2011, 5) 74-years old gentleman Exertional chest pain Warfarin with good INR control Ex-smoker, social(?)
More informationDisclosures. Dr. Scirica has also served as a consultant for Lexicon, Arena, Gilead, and Eisai.
Disclosures Benjamin M. Scirica, MD, MPH, is employed by the TIMI Study Group, which has received research grants from Abbott, AstraZeneca, Amgen, Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb,
More informationDisclosure Slide. Controversies in Anticoagulation. Presenter Disclosure Information. Challenges in Anticoagulation
1:15 2:15 PM Challenges in Anticoagulation SPEAKER Nasser Lakkis, MD, FACC, FSCAI Presenter Disclosure Information The following relationships exist related to this presentation: Nasser Lakkis, MD, FACC,
More informationThe Myth of Class Effect Antithrombotics Christopher Cannon, MD
The Myth of Class Effect Antithrombotics Christopher Cannon, MD Cardiovascular Division Brigham and Women s Hospital Associate Professor of Medicine Harvard Medical School Senior Investigator, TIMI Study
More informationLet s Gi e The So ethi g To Clot About: Controversies in Anticoagulation
Let s Gi e The So ethi g To Clot About: Controversies in Anticoagulation Janna Beavers, MS, PharmD, BCPS Cardiology Clinical Pharmacy Specialist WakeMed Health & Hospitals Raleigh, NC March 13, 2018 Pharmacist
More informationDOUBLE or TRIPLE ANTI-TROMBOTIC THERAPY in ACS. Maarten L Simoons Thoraxcenter - Erasmus MC Rotterdam - The Netherlands
DOUBLE or TRIPLE ANTI-TROMBOTIC THERAPY in ACS Maarten L Simoons Thoraxcenter - Erasmus MC Rotterdam - The Netherlands RECENT DEVELOPMENTS Better anti-platelet agents: Prasugrel and Ticagrelor to replace
More informationOptimal 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
More informationTriple Therapy: A review of the evidence in acute coronary syndrome. Stephanie Kling, PharmD, BCPS Sanford Health
Triple Therapy: A review of the evidence in acute coronary syndrome Stephanie Kling, PharmD, BCPS Sanford Health Objectives 1. Describe how the presented topic impacts patient outcomes. 2. Review evidence
More informationNOACs in AF. Dr Colin Edwards Auckland Heart Group and Waitemata DHB. Dr Fiona Stewart Auckland Heart Group and Auckland DHB
NOACs in AF Dr Colin Edwards Auckland Heart Group and Waitemata DHB Dr Fiona Stewart Auckland Heart Group and Auckland DHB Conflict of Interest Dr Fiona Stewart received funding from Pfizer to attend the
More informationPatient with high risk for bleeding
Will Apixaban change practice in atrial fibrillation Luncheon Satellite Sponsored by Pfizer Patient with high risk for bleeding Prof. Amos Katz M.D August 2012: patient background 67-year-old woman History
More informationThe Korean Society of Cardiology COI Disclosure
The Korean Society of Cardiology COI Disclosure Name of First Author: Yongwhi Park The authors have no financial conflicts of interest to disclose concerning the presentation 2017 Annual Spring Scientific
More informationUpdated 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
More informationΚωνσταντίνος 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
More informationTicagrelor 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
More informationTransient Atrial Fibrillation and Risk of Stroke after Acute Myocardial Infarction
Transient Atrial Fibrillation and Risk of Stroke after Acute Myocardial Infarction Doron Aronson MD, Gregory Telman MD, Fadel BahouthMD, Jonathan Lessick MD, DSc and Rema Bishara MD Department of Cardiology
More informationΔιάρκεια 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
More informationDecline in CV-Mortality
Lipids id 2013 What s Changed? Christopher Granger, MD Disclosure Research contracts: AstraZeneca, GSK, Merck, Sanofi- Aventis, BMS, Pfizer, The Medicines Company, Medtronic Foundation, and Boehringer
More informationRecognizing the High Risk NSTEMI Patient for Early Appropriate Therapy
Recognizing the High Risk NSTEMI Patient for Early Appropriate Therapy Learning Objectives Learn to recognize the high risk patient Discuss effective management of a high risk NSTEMI patient Review CCS
More informationESC Congress 2012, Munich
ESC Congress 2012, Munich Anticoagulation in Atrial Fibrillation 2012: Which Anticoagulant for Which Patient? Stefan H. Hohnloser J.W. Goethe University Frankfurt am Main S.H.H. has served as a consultant,
More informationClopidogrel 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
More informationCase Challenges in ACS The Very Elderly in the Cath Lab
Case Challenges in ACS The Very Elderly in the Cath Lab Sameh Salama, MD, FSCAI Professor of Cardiology, Cairo University 86 yrs old male IDDM (controlled on insulin and oral hypoglycemics) Hypertensive
More informationAnti-thromboticthrombotic drugs
Atrial Fibrillation 2011: Anticoagulation strategies and clinical outcomes Panos E. Vardas President Elect of the ESC, Prof. of Cardiology, University Hospital of Crete Clinical outcomes affected by AF
More informationSecondary Preven-on of Thromboembolic Stroke: Clinical Data and Recommenda-ons from the ESC Atrial Fibrilla-on Guideline Update 2012
Secondary Preven-on of Thromboembolic Stroke: Clinical Data and Recommenda-ons from the ESC Atrial Fibrilla-on Guideline Update 2012 Professor Dan Atar Head, Dept. of Cardiology Councillor of the ESC,
More informationP 2 Y 12 Receptor Inhibitors
P 2 Y 12 Receptor Inhibitors Clopidogrel, Prasugrel and Ticagrelor Which Drug and for Whom? Cheol Whan Lee, MD Professor of Medicine, University of Ulsan College of Medicine, Heart Institute, Asan Medical
More informationDISCLOSURE. What I am Talking About. Rational Use of Antiplatelet Agents. Aspirin. Tom DeLoughery, MD MACP FAWM
Rational Use of Antiplatelet Agents DISCLOSURE Relevant Financial Relationship(s) Speaker Bureau None Tom DeLoughery, MD MACP FAWM Oregon Health and Sciences University What I am Talking About 1. Current
More informationClinical Seminar. Which Diabetic Patient is a Candidate for Percutaneous Coronary Intervention - European Perspective
Clinical Seminar Which Diabetic Patient is a Candidate for Percutaneous Coronary Intervention - European Perspective Stephan Windecker Department of Cardiology Swiss Cardiovascular Center and Clinical
More informationFred Kusumoto Professor of Medicine
Fred Kusumoto Professor of Medicine Faculty photo will be placed here Kusumoto.Fred@mayo.edu 2015 MFMER 3543652-1 Atrial Fibrillation Presentation Subtitle Here Mayo School of Continuous Professional Development
More informationFølgende dias er fremlagt ved DCS / DTS Fællesmøde 13. januar 2011 og alle rettigheder tilhører foredragsholderen. Gengivelse må kun foretages ved
. Følgende dias er fremlagt ved DCS / DTS Fællesmøde 13. januar 2011 og alle rettigheder tilhører foredragsholderen. Gengivelse må kun foretages ved tilladelse Antithrombotic therapy in Atrial Fibrillation
More informationAdditional Contributor: Glenn Levine (USA).
2017 ESC Focused Update on Dual Antiplatelet Therapy in Coronary Artery Disease developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) The Task Force for the Management
More informationP2Y 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,
More informationNew options in Stroke Prevention in AF Paul Dorian University of Toronto St Michael s Hospital
New options in Stroke Prevention in AF Paul Dorian University of Toronto St Michael s Hospital Disclosures: Honoraria, research support, and consulting f Sanofi, Boehringer-Ingleheim, Portola, BMS, Bayer,
More informationAntiplatelet 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
More informationLearning 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
More informationOptimal 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
More informationΑντιαιμοπεταλιακη αγωγη (ποια, πο τε και για πο σο)
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 I, Dimitrios
More informationWhat s New in the AF Guidelines
Impact on New AF Guidelines on Heart Failure Management Gothenburg - May 22 nd 2011 Europace (2010) 12, 1360-420 http://europace.oxfordjournals.org JACC (2011) 57, 223-42 http://www.cardiosource.org What
More informationCOPYRIGHT. Harvard Medical School
Agenda New Rapid Rule Out Strategy General Guidelines and Therapies Assessing Patient Risk Timing of Catheterization Navigating Anticoagulant/Antiplatelet Choices Newer Choices and new data The Future
More informationΠροβληματισμοι 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
More informationAntithrombotics in Stroke management
Antithrombotics in Stroke management Faculty: Robert Beveridge Relationships with commercial interests: Grants/Research Support: N/A Speakers Bureau/Honoraria: Astra Zeneca, Bayer, Boerhinger Ingelheim,
More informationDepartment of Medicine III, Martin Luther-University Halle, Germany b. Unità Operativa di Cardiologia, Ospedale Maggiore, Bologna, Italy c
Comparison of CHADS 2 -Score with CHA 2 DS 2 VASc-Score in a prospective multicenter registry on patients with atrial fibrillation undergoing coronary artery stenting -First results from the AFCAS-trial-
More informationWHICH ANTITHROMBOTIC REGIMEN? Action Study Group Institut de Cardiologie - Pitié-Salpêtrière Hospital Paris, France.
TAVI WITH ATRIAL FIBRILLATION: WHICH ANTITHROMBOTIC REGIMEN? G. MONTALESCOT (PARIS, FR) Action Study Group Institut de Cardiologie - Pitié-Salpêtrière Hospital Paris, France www.action-cœur.org Dr. Montalescot
More informationQuoi de neuf en cardio-gériatrie? Pr Olivier Hanon Hôpital Broca, Paris
Quoi de neuf en cardio-gériatrie? Pr Olivier Hanon Hôpital Broca, Paris Déclaration de relations professionnelles et liens d intérêt Novartis, Daiichi-Sankyo, Boehringer-Ingelheim, Bayer, BMS, Pfizer,
More information