2) Accredited for 0.5 credits by @academiccme: physicians, nurses, pharmacists! Expert faculty @dlbhattmd. Supported by Abbott, AstraZeneca, Bayer, Chiesi, NovoNordisk. Follow this thread for credit. #cardiotwitter #medtwitter
— cardio-met (@cardiomet_CE) March 8, 2021
4) No angina now, prev had abnl stress test -> cath -> moderate 3v disease but no lesion warranting revasc.
— cardio-met (@cardiomet_CE) March 8, 2021
Echo today shows nl systolic function.
His ABI at rest today is 0.7 on R and 0.8 on L.
He is referred to cardiac rehab/walking program
6) Please enter your choice and return tomorrow to see the results and more on this case! @herbaronowMD @SVM_tweets @VMJ_SVM
— cardio-met (@cardiomet_CE) March 8, 2021
8) . . . and is quite prevalent, especially as the population ages . . . pic.twitter.com/5b80JAGfFI
— cardio-met (@cardiomet_CE) March 9, 2021
10) So our patient is currently on:
— cardio-met (@cardiomet_CE) March 9, 2021
ASA 81mg
Atorvastatin 80 mg (last LDL 54)
Ramipril 10 mg (current BP 134/82)
SGLT2i (last HbA1c 6.4%)
12) Answer the poll and return tomorrow for results and more education! @Drroxmehran @CMichaelGibson @ASchmaier @cpcannon @KrittanawongMD
— cardio-met (@cardiomet_CE) March 9, 2021
14) . . . contemporary evidence would support the addition of low-dose rivaroxaban, the only DOAC systematically studied in PAD. There is good biologic plausibility for a combined therapeutic effect with this patient’s current ASA dose: pic.twitter.com/KLgZPgQ8KI
— cardio-met (@cardiomet_CE) March 10, 2021
16) The efficacy results of COMPASS showed that riva alone was not more effective than ASA alone, but the lowest event rates occurred with rivaroxaban 2.5 BID + ASA 100 QD . . . pic.twitter.com/tcCtB8vPPo
— cardio-met (@cardiomet_CE) March 10, 2021
18) As in the overall trial, the subset of patients in the COMPASS-Lower Extremity PAD showed substantial risk reduction for cardiac and limb events among those taking riva+ASA: pic.twitter.com/PDYBP1sO5D
— cardio-met (@cardiomet_CE) March 10, 2021
20) . . . COMPASS-eligible patients experienced a higher rate of the primary outcome than patients actually enrolled in the ASA control arm of COMPASS, supporting combo therapy. (Darmon et al, EHJ 2018;39(9):750-757)
— cardio-met (@cardiomet_CE) March 10, 2021
22) Given their higher baseline risk, the absolute benefits appeared larger in those with diabetes mellitus, including a 3-fold greater reduction in all-cause mortality. pic.twitter.com/VoDulRyPOS
— cardio-met (@cardiomet_CE) March 10, 2021
24) Select one:
— cardio-met (@cardiomet_CE) March 10, 2021
(a) thrombus is often present
(b) the majority of cases are due to gradually worsening atherosclerotic stenosis
(c) almost all are due to thromoboembolism, largely due to prev undetected AF
26) Welcome back! I am @DLBHATTMD. The correct answer is A—thrombus if often present, as per a very instructive study by Narula et al in JACC 2018: pic.twitter.com/tBM2KqD75j
— cardio-met (@cardiomet_CE) March 11, 2021
28) This pathology lends further support to the potential efficacy of an anticoagulant in selected patients with PAD. Antiplatelet and anticoagulant pathways are interrelated and each contributes to thrombosis . . .
— cardio-met (@cardiomet_CE) March 11, 2021
30) @ma_hussainMD pic.twitter.com/IZdO4kkZOE
— cardio-met (@cardiomet_CE) March 11, 2021
32) So per that flow chart, our patient, who has symptomatic PAD with clear markers of increased ischemic risk but limited risk for bleeding, might benefit from the addition of low-dose rivaroxaban, per label at 2.5mg BID, to his ASA dose.
— cardio-met (@cardiomet_CE) March 11, 2021
33) You made it! Free CE/#CME! #Physicians, #nurses, and #pharmacists, now go to https://t.co/2k9n5gFnqW and claim your credit! I am @dlbhattmd. Follow @cardiomet_CE for more tweetorials! #medtwittter #cardiotwitter
— cardio-met (@cardiomet_CE) March 11, 2021