2) The @cardiomet_ce program is supported by educational grants from AstraZeneca, Bayer, Boehringer Ingelheim Pharmaceuticals Inc and Eli Lilly Company, Bristol Myers Squibb & its Alliance partner Pfizer Inc, Chiesi, & Esperion. This program is intended for healthcare providers.
— cardio-met (@cardiomet_CE) January 4, 2022
4) @cpcannon appreciates support on this program from @MarcBonaca. #CardioTwitter #medtwitter
— cardio-met (@cardiomet_CE) January 4, 2022
Let’s start off with a case! 65F presents for follow-up visit with #cardiologist. PMH sig for #T2D x 10y (on metformin), elevated chol (rosuvastatin 5mg), mild htn (lisinopril). pic.twitter.com/EkK7WwXQ2l
6) On PE, her BP 140/65, HR 55, weight 123 pounds. Clear lungs, nl S1, S2, +S4. Ext – no edema, but only trace to 1+ pulses.
— cardio-met (@cardiomet_CE) January 4, 2022
Labs: LDL 79, Trig 175, eGFR 50, HbA1c 6.9%.
ABI shows 0.6 on R and 0.8 on L
Let’s talk about her risk assessment & whether she needs changes in therapy.
8) The answer: at least 2x higher risk: pic.twitter.com/pdlswE1CMU
— cardio-met (@cardiomet_CE) January 4, 2022
10) She is high risk, & she is symptomatic – so she is referred for revascularization and has successful angioplasty of superficial femoral artery (SFA) on R side.
— cardio-met (@cardiomet_CE) January 4, 2022
What should be done about her #antithrombotic therapy?
12) Adding rivaroxaban 2.5BID had a significant effect, with NNT to prevent primary outcome (acute limb ischemia, major amputation for vascular cause, myocardial infarction, ischemic stroke, CV death) dropped over 3 years of therapy to 39. pic.twitter.com/G1fZ9NiA7f
— cardio-met (@cardiomet_CE) January 4, 2022
13b) Though bleeding was⬆️w/rivaroxaban+ASA, the incidence was low, w/no significant⬆️in fatal bleeding, intracranial hemorrhage, or postprocedural bleeds req’ing intervention. pic.twitter.com/EfKl2u1hTQ
— cardio-met (@cardiomet_CE) January 4, 2022
15) The COMPASS trial (https://t.co/7aNfsiMHnG) showed that low-dose rivaroxaban taken BID + ASA reduced major adverse cardiovascular and limb events when compared with ASA alone. Although major bleeding was increased, fatal or critical organ bleeding was not.
— cardio-met (@cardiomet_CE) January 4, 2022
17) The PEGASUS Study (https://t.co/JVgfzwVlOs) evaluated the efficacy and safety of #ticagrelor on major CV events (MACE) in patients with a prior MI more than 1y prev. Overall, treatment with ticagrelor significantly⬇️MACE but⬆️major bleeding risk (tho not fatal or #ICH).
— cardio-met (@cardiomet_CE) January 4, 2022
19) So back to our patient. After her revascularization procedure, what additional changes should be considered?
— cardio-met (@cardiomet_CE) January 4, 2022
21) Welcome back! You're earning FREE CE/#CME as we talk about optimizing the care of pts with #PAD after a #revascularization procedure. Thanks for joining us! I am @cpcannon & @cardiomet_ce is your ONLY source for #accredited #tweetorials.
— cardio-met (@cardiomet_CE) January 5, 2022
So re yesterday's poll (tweet #19):
22b) Here's an excerpt from @AmDiabetesAssn Diabetes Care 2022 (🔓https://t.co/TUvZqBCpYB) pic.twitter.com/W5uEUjlspO
— cardio-met (@cardiomet_CE) January 5, 2022
24) So you're OK if you answered B, C, or D. Here's the support for ezetimibe: pic.twitter.com/gEmxgi0EDV
— cardio-met (@cardiomet_CE) January 5, 2022
26) And not to be outdone, here's support for icosapent ethyl: pic.twitter.com/jz13JMmiuG
— cardio-met (@cardiomet_CE) January 5, 2022
28a) Congruent with that, our patient had her therapy intensified after her procedure:
— cardio-met (@cardiomet_CE) January 5, 2022
Antithrombotic therapy
Add rivaroxaban 2.5 mg BID to aspirin 100 mg QD
Lipid-modifying therapy
29a) In conclusion, to drive better outcomes post PAD revasc:
— cardio-met (@cardiomet_CE) January 5, 2022
(a) Keep in mind that patients with PAD, particularly those with prior lower extremity revascularization, are at very high risk of adverse limb events
30) And that's it! You made it! Free CE/#CME 🇺🇸🇨🇦🇪🇺🇬🇧 … all you have to do is go to https://t.co/lqTDQOQjdN and you'll get your certificate in 2-3 minutes! I am @cpcannon. Please FOLLOW US for more #accredited #tweetorials in #cardiometabolic medicine.
— cardio-met (@cardiomet_CE) January 5, 2022