. . . formulation and dosing. Don’t miss it–FOLLOW US NOW! @cpcannon @AnnMarieNavar @DrM_ODonoghue @DrMarthaGulati @practicalcardio @GuyattGH @DrMauricioCohen @SVRaoMD @ASPCardio @PlateletDoc @stephanamayer @CMichaelGibson @JJheart_doc @DrSheilaSahni @mmamas1973 @Drroxmehran pic.twitter.com/pemkGWD9TK
— cardio-met (@cardiomet_CE) December 6, 2021
2) This tweetorial is supported by an educational grant from PLx Pharma, and is intended for healthcare professionals. Faculty disclosures are listed at https://t.co/gvXca4G9Xm and similar programs on #antiplatelets, still available for credit, are at https://t.co/WfqOL6AhBw.
— cardio-met (@cardiomet_CE) December 7, 2021
4) The goal of REACH was to categorize the risk of cardiovascular events in stable outpatients with various initial manifestations of #atherothrombosis using simple clinical descriptors.
— cardio-met (@cardiomet_CE) December 7, 2021
6) Patients with stable #coronary, #cerebrovascular, or #PAD peripheral artery disease (33.7%) had a lower risk (12.2%), and pts without established #atherothrombosis but with risk factors only (17.8%) had the lowest risk (9.1%; p < 0.001 for all comparisons). pic.twitter.com/mPr0KELjkm
— cardio-met (@cardiomet_CE) December 7, 2021
8) Aspirin and #statin use were both independently associated with a lower rate of CV death, MI, and stroke. From https://t.co/UjmkSQYRwK: pic.twitter.com/8zn4pBFo6D
— cardio-met (@cardiomet_CE) December 7, 2021
10) While there has been some controversy about #aspirin in primary prevention based on conflicting trial data in different populations, for secondary prevention aspirin remains an important part of the core therapies.
— cardio-met (@cardiomet_CE) December 7, 2021
12) The ASCEND trial did in fact show a significant reduction in the primary endpoint with #aspirin vs placebo in #diabetes. See 🔓full text at https://t.co/mxsyLFvATq. pic.twitter.com/DlXupoYRgz
— cardio-met (@cardiomet_CE) December 7, 2021
14) Per that document, released at #WCIRDC2021 just last week, patients with two or more CV risk factors (for example, elevated LDL-C, diabetes, cigarette smoking, family history of CVD) may benefit from low dose aspirin if at low risk of bleeding. pic.twitter.com/gaNmaIJwx1
— cardio-met (@cardiomet_CE) December 7, 2021
16) Meanwhile, let’s see what you think. In a patient with #Afib and #CAD who undergoes #PCI, what is the recommended LONGEST duration of “triple” therapy (ASA+#P2Y12i+oral anticoagulant)?
— cardio-met (@cardiomet_CE) December 7, 2021
18) Welcome back! We are talking #ASA for #cardiovascular event risk reduction. This is your source for CE/#CME-accredited, serialized education on Twitter! I am @DLBHATTMD. @CardioNerds @radcliffeCARDIO @MGHCVFellows @a_l_bailey
— cardio-met (@cardiomet_CE) December 8, 2021
20) Full text is at https://t.co/VAb75mpROA. Patients with #AFib and #CAD who then undergo #PCI are challenging for their optimal antithrombotic management because they require oral #anticoagulation for the prevention of cardiac thromboembolism . . .
— cardio-met (@cardiomet_CE) December 8, 2021
22) However, that one-month period of triple therapy is the longest; data from AUGUSTUS (@RenatoDLopes1 et al: 🔓https://t.co/rshM9Rxn8U) suggest that longer than a week is rarely advisable.
— cardio-met (@cardiomet_CE) December 8, 2021
24) The best-known de-escalation study to date (outside afib) is #TWILIGHT by @cardiomet_ce core faculty @Drroxmehran et al,🔓https://t.co/PMhkWuyA6t
— cardio-met (@cardiomet_CE) December 8, 2021
26) The primary prevention guidelines do allow use of #aspirin among select high #CV risk, low #bleeding risk patients (🔓https://t.co/6kE2UosGsQ) pic.twitter.com/PJgsb8ZuRx
— cardio-met (@cardiomet_CE) December 8, 2021
28) So, there IS an enduring role for #aspirin in #cardiovascular #wellness & #prevention. But how much to give? There have been questions about the appropriate dose of chronic aspirin when used for cardiovascular purposes. See https://t.co/iakxiUvC8d. pic.twitter.com/eYf7WmAH3c
— cardio-met (@cardiomet_CE) December 8, 2021
30) . . . of cardiovascular death, myocardial infarction, or stroke at 30 days (4.2% v 4.4%) or major #bleeding (2.3% v 2.3%). There was a significant⬆️in the incidence of minor bleeding among patients who received higher-dose aspirin (hazard ratio, 1.13; p=0.04).
— cardio-met (@cardiomet_CE) December 8, 2021
32) The more recent ADAPTABLE trial (full text free at https://t.co/HGgyQxcYUr) did not find any major differences in efficacy or safety of 81 mg or 325 mg of #aspirin in terms of either #efficacy or #safety. pic.twitter.com/HeLzOH4ktn
— cardio-met (@cardiomet_CE) December 8, 2021
34) So now we turn attention to another area of uncertainty with respect to #aspirin: what is the optimal formulation? If you follow us here at @cardiomet_CE, you should have seen a recent #tweetorial from @CMichaelGibson on this subject. If not, check it out & get credit at …
— cardio-met (@cardiomet_CE) December 8, 2021
Your answer to quiz (Tweet 35): VOTE NOW!!
— cardio-met (@cardiomet_CE) December 8, 2021
39) … in https://t.co/ve6GpFB3tv. Absorption of PL-ASA (blue line) was 5X > ECASA (gray) (p<0.0001). Absorption of PL-ASA & "plain" ASA (black) overlap. For you #PK geeks, AUC of plasma concentrations after 325 mg dosing were: PL-ASA (2523), plain ASA (1964), ECASA (456).
— cardio-met (@cardiomet_CE) December 9, 2021
41) The dyspepsia that aspirin can cause may decrease adherence, and one strategy that has been proposed is use of proton pump inhibitors #PPI, though that does mean an additional long-term medication (https://t.co/sViATb1bZo).
— cardio-met (@cardiomet_CE) December 9, 2021
43) But several small older studies suggest that the enteric coating can⬇️absorption of aspirin and may therefore have less early #antiplatelet effect. The phospholipid coated aspirin (#PL-ASA) referenced above was found to result in more immediate #antiplatelet effect than ECASA pic.twitter.com/aGCgDPbORq
— cardio-met (@cardiomet_CE) December 9, 2021
45) The clinical impact of those pharmacokinetic & pharmacodynamic observations is uncertain & requires testing in future randomized trials, but PL-coated aspirin was also compared with plain ASA & found to ⬇️short-term #GI ulceration on endoscopy (https://t.co/MMaX413wj3). pic.twitter.com/m76o6oeTFx
— cardio-met (@cardiomet_CE) December 9, 2021
47) PL-ASA is a novel, already FDA-approved phospholipid-ASA formulation in a liquid-filled capsule that has been shown to be bioequivalent to plain ASA, yields faster & more complete absorption after a single 81mg dose & more predictable #antiplatelet effect compared to ECASA. pic.twitter.com/lXawb9DgAn
— cardio-met (@cardiomet_CE) December 9, 2021
48) And that's it! You made it! Claim your 0.5h CE/#CME at https://t.co/NDpDMRP2Jf now, & FOLLOW US for more accredited #tweetorials in #cardiometabolic medicine! Also JOIN US at @ckd_ce for more FREE credit focused on #CKD! Happy Holidays! I am @DLBHATTMD.
— cardio-met (@cardiomet_CE) December 9, 2021