1) Welcome to our accredited tweetorial on the evidence basis for duration of #DAPT after #ACS/#PCI. This activity is intended for healthcare professionals and is accredited for #physicians, #nurses, and #pharmacists by @academiccme . . .
— cardio-met (@cardiomet_CE) May 18, 2021
2) First, a poll. When seeing a patient 1yr following an #ACS for which the patient had #PCI – how long do you treat with #DAPT of ASA and P2Y12 inhibitor?
— cardio-met (@cardiomet_CE) May 18, 2021
a) I stop after 1 year
b) I try to go 2-2 1/2 years
c) indefinitely
d) I assess bleed + thrombotic risk & individualize
4) First, we should acknowledge some confusion years ago – from the initial moderate-sized studies that were underpowered for the Major Adverse Cardiac or Cerebrovascular Events (MACCE), and so they gave mixed results pic.twitter.com/WVoOxSL5jD
— cardio-met (@cardiomet_CE) May 18, 2021
6) The overall DAPT trial results found a balance: a 29% reduction in MACCE but a 60% relative increase in moderate or severe bleeding. Thus significant benefit but balance by increased bleeding risk.
— cardio-met (@cardiomet_CE) May 18, 2021
The absolute differences in events are shown here: pic.twitter.com/TodnFZevZo
. . . in absolute risk, it was about a 1.2% absolute reduction in MACE, but a 1.2 and 1.5% absolute increase in major bleeding for the 60 and 90 mg doses of ticagrelor – about a 1:1 trade off. pic.twitter.com/Cm4xl1TbIL
— cardio-met (@cardiomet_CE) May 18, 2021
9) So… Would one just stop and avoid bleeding (but miss out on opportunity to reduce MACE? or continue P2Y12 for a total of 2-2 ½ yrs more? This also begs the question: could we find who benefits more and who has less bleeding risk so we can target therapy?
— cardio-met (@cardiomet_CE) May 18, 2021
10) Tune in tomorrow for that discussion! @DrMauricioCohen @mmamas1973 @SABOURETCardio @DLBHATTMD @SVRaoMD @DocSavageTJU @GreggWStone @gabrielsteg @Drroxmehran @fischman_david @Hragy @ammozid @GiuseppeGalati_ @novitskiynic @nolanjimradial @Pooh_Velagapudi @ziadalinyc
— cardio-met (@cardiomet_CE) May 18, 2021
12) . . . and two 3.0 mm DES stents placed in a thrombotically occluded D1. His early echo had a reduced ejection fraction of 45% with anteroapical hypokinesis.
— cardio-met (@cardiomet_CE) May 19, 2021
14) He has no chest pain or SOB with exertion. He did note, when he cuts himself, it bleeds for longer than usual – and he applies pressure. He also bruises easily. Physical exam BP 122/74 and heart rate 54. His LDL is 56 mg/dl.
— cardio-met (@cardiomet_CE) May 19, 2021
16) Select your best answer and return tomorrow for results and more education! @DrDerekConnolly @HeartBobH @HeartOTXHeartMD @vlgmrc @SarahFairley7 @drandrewsharp @djc795 @RodrigoBagur @ajaykirtane @cardioPCImom @ncurzen @jedicath @YMurasato @rahilraf @lorenzo2509 @rwyeh
— cardio-met (@cardiomet_CE) May 19, 2021
18) So – for my patient, exactly one year post STEMI and 3 DES, on ASA 81 mg daily and ticagrelor 90 mg bid, do we continue DAPT or now? There are 2 ways to decide: one – clinical judgment (why not, he is doing fine), or use a risk score to help decide.
— cardio-met (@cardiomet_CE) May 20, 2021
20) It uses Prior Bleed, Age, Hemoglobin, WBC, and Creat Cl to calculate a score. They have a web calculator https://t.co/wMpBBM9IAJ
— cardio-met (@cardiomet_CE) May 20, 2021
. . . Thus, high PRECISE DAPT score would be a good reason to stop DAPT at this time point. pic.twitter.com/8ijjRhBBxr
— cardio-met (@cardiomet_CE) May 20, 2021
23) The DAPT Risk Score is shown below, and the median of 2 is an excellent cut point to either continue DAPT or stop it. pic.twitter.com/dseVfPp6Ha
— cardio-met (@cardiomet_CE) May 20, 2021
25) My patient has a DAPT score of 2 (MI with presentation and one of his stents was < 3mm), so we elected to continue DAPT. However, at the 1 yr time, the 60 BID dose is the approved dose, and he has had some minor bruising – so this might help him have less bleeding long-term.
— cardio-met (@cardiomet_CE) May 20, 2021
27) I hope this is helpful to you all! This is how I practice medicine on this topic!
— cardio-met (@cardiomet_CE) May 20, 2021
28) That’s it! You made it! Free CE/#CME! Now go to https://t.co/tRQ87D7ITQ and claim your credit! I am @cpcannon. Follow @cardiomet_CE for more tweetorials, and visit us at https://t.co/U6Mo1oSwIh for unrolled programs where credit opportunity is still active!
— cardio-met (@cardiomet_CE) May 20, 2021