2) This educational program is accredited for 0.5h CE/#CME & is intended for healthcare professionals. Author disclosures & Accreditation Statement are at https://t.co/gvXca4G9Xm. Visit https://t.co/NOg9ub8H2q for previous programs for more credit! #FOAMed @MedTweetorials
— cardio-met (@cardiomet_CE) July 26, 2022
4) Let’s start off with a case! pic.twitter.com/VdmtYI3yO7
— cardio-met (@cardiomet_CE) July 26, 2022
6) Relevant History/Laboratory Studies show she is a diabetic and former smoker. She has suffered an NSTEMI in the past and her eGFR is 70 ml/min. Her most recent vascular ultrasound shows > 50% stenosis of her SFA’s bilaterally. pic.twitter.com/A8lFm4Otzc
— cardio-met (@cardiomet_CE) July 26, 2022
8) Want to refresh your memory before answering?#COMPASS_PAD subanalysis: 🔓https://t.co/yXuWiQ8DgG (lead author @kaplovitch 🇨🇦)#VOYAGER_PAD: 🔓https://t.co/cYX6kwAt7i (lead author is @cardiomet_ce faculty @MarcBonaca)
— cardio-met (@cardiomet_CE) July 26, 2022
10) Patients with #PAD are at ⬆️ risk of athero-thrombo-embolism; pathological specimen analysis from #BKA and #AKA in this pts show distal arteries are characterized by #layered #thrombus. pic.twitter.com/HuiILHWY3h
— cardio-met (@cardiomet_CE) July 26, 2022
11b) In the COMPASS trial analyses in JACC 2019 – this was clearly shown.
— cardio-met (@cardiomet_CE) July 26, 2022
🔓https://t.co/jkypZrZRdp pic.twitter.com/8mwzmJg6ku
13) Your resident asks you what is the big deal about acute limb ischemia #ALI?
— cardio-met (@cardiomet_CE) July 26, 2022
You respond – highlighting that #ALI is akin to the #STEMI of coronary artery disease #CAD, and they have 1-yr risk of vascular #amputation of 20.5% & death of 8.3% .
See 🔓https://t.co/jBfPAaxqlb. pic.twitter.com/m9gLQeBql3
15) Furthermore, in #COMPASS, being on #rivaroxaban + #ASA had a better prognosis after #MALE than those on #aspirin alone. Again see 🔓https://t.co/jBfPAaxqlb. pic.twitter.com/xktZu1uitL
— cardio-met (@cardiomet_CE) July 26, 2022
16b)
— cardio-met (@cardiomet_CE) July 26, 2022
🦵Compared to aspirin, Riva/Aspirin combination prevents MALE, vascular interventions, and total peripheral vascular outcomes
🦵Outcomes after MALE are worse for aspirin-treated patients
🦵Antithrombotic management after MALE is very heterogeneous pic.twitter.com/1HIhDA98Nv
17b) What did you think? It's c, because (probably intuitively) it is LONGER target lesion length that is associated with ⬆️risk of ALI.
— cardio-met (@cardiomet_CE) July 26, 2022
Furthermore, incident ALI was assoc'd w/ subsequent all-cause mortality (HR 2.59 [95% CI, 1.98–3.39]) & major amputation (24.87 [18.68–33.12]).
18a) In #EUCLID, pts with #PAD were randomized to #ticagrelor or #clopidogrel. Turns out there was no difference between the #antiplatelet agents, but it is interesting to examine predictors of #ALI – which again are concordant with COMPASS and VOYAGER . . .
— cardio-met (@cardiomet_CE) July 26, 2022
19a) As per figure above, among 13,885 patients, 232 (1.7%) had 293 #ALI hospitalizations (0.8 per 100 patient-years). Pts w/ vs w/o #ALI more often had prior peripheral revascularization, lower baseline #ABI, and #atrialfibrillation
— cardio-met (@cardiomet_CE) July 26, 2022
20a) So what is the #bottom_line? #MALE such as #ALI should be prevented if at all possible, b/c if it develops the pt has ⬆️ risk of needing a major amputation, & ⬆️ risk of #CV events, including death ☠️ pic.twitter.com/PnxuBLouEq
— cardio-met (@cardiomet_CE) July 26, 2022
20c) Low-dose #rivaroxaban + ASA significantly ⬇️risk of #ALI, as seen in a meta-analysis of data from #COMPASS & #VOYAGER_PAD. Overall populations with #PAD on left; symptomatic 🦵 PAD on right.
— cardio-met (@cardiomet_CE) July 26, 2022
See 🔓https://t.co/qzt5MZKxIg pic.twitter.com/rWQpk1UZfK
21) And that's it! You just earned 0.5hr CE/#CME 🇨🇦🇺🇸🇪🇺🇬🇧 for #physicians #PhysicianAssociate #nurses #Pharmacist. Go to https://t.co/UfIP6jKprb and grab your 🆓credit! I am @DrSoniaAnand1 & I encourage you to FOLLOW @cardiomet_CE (and @ckd_ce) for more #accredited #tweetorials!
— cardio-met (@cardiomet_CE) July 26, 2022