1) Welcome to a tweetorial on de-escalation of P2Y12 inhibitor monotherapy after #PCI! Accredited for 0.50 credits by @academiccme: physicians, nurses, pharmacists! Expert faculty @drroxmehran
— cardio-met (@cardiomet_CE) March 3, 2021
3) 69 yo M presenting with chest pain & dyspnea of 1h duration. MHx: HTN, Dyslipidemia, and BPH. 30 pack-year smoking Hx.
— cardio-met (@cardiomet_CE) March 3, 2021
5) … Pt undergoes PCI w/ everolimus-eluting stent in proximal RCA, distal RCA, and Cx-OM1. Pt is discharged on DAPT with ticagrelor and ASA.
— cardio-met (@cardiomet_CE) March 3, 2021
7) When deciding on DAPT duration, this patient is considered to be at:
— cardio-met (@cardiomet_CE) March 3, 2021
a.High bleeding and high ischemic risk
b.High ischemic risk only
c.High bleeding risk only
d.Need more info
8) Please return tomorrow for poll results and further discussion. @vijaykunadian @mmamas1973 @rwyeh
— cardio-met (@cardiomet_CE) March 3, 2021
10) And based on the recent #ARC #HBR criteria, this patient is NOT at high bleeding risk: pic.twitter.com/qeBBVpoG8J
— cardio-met (@cardiomet_CE) March 4, 2021
12) #TRACER trial: 12,944 pts with NSTE-ACS; risk of death after MI was significantly lower than after BARC 3 bleeding (RR 0.22; 95% CI 0.13–0.36; P<0.001). pic.twitter.com/OjNILTOb5c
— cardio-met (@cardiomet_CE) March 4, 2021
14) There are several clinical issues with ASA use, most importantly increased GI bleeding.
— cardio-met (@cardiomet_CE) March 4, 2021
16) Answer the poll, come back tomorrow, and we'll continue. @academiccme #medtwitter #cardiotwitter #cardiology @ajaykirtane @EricSecemskyMD
— cardio-met (@cardiomet_CE) March 4, 2021
18) ASA might abolish or decrease the proposed anti-thrombotic effect of P2Y12 receptor inhibitors that is mediated by the amplification of the anti-platelet effect of inhibitory prostaglandins such as PGI2.
— cardio-met (@cardiomet_CE) March 5, 2021
20) Experimental studies have shown comparable inhibition of hemostatic system activation between P2Y12 inhibitor monotherapy and DAPT.
— cardio-met (@cardiomet_CE) March 5, 2021
22) #GLOBAL-LEADERS (n=15,968): ticagrelor + ASA for 1m followed by ticagrelor alone for 23m was not superior to 12m of standard DAPT followed by 12m of ASA alone for prevention of death & MI at 2y post-PCI. https://t.co/XjAtXBt6my
— cardio-met (@cardiomet_CE) March 5, 2021
24) SMART-CHOICE (n=2,993): P2Y12 inhibitor monotherapy after 3 months of DAPT resulted in non-inferior rates of MACCE, compared with 12-month DAPT.
— cardio-met (@cardiomet_CE) March 5, 2021
JAMA. 2019;321(24):2428-2437. doi:10.1001/jama.2019.8146
26) #TWILIGHT included patients with high-risk features: pic.twitter.com/0GHMAztOEJ
— cardio-met (@cardiomet_CE) March 5, 2021
28) #TICO: Dropping ASA after 3 months of DAPT (ASA+Tica) reduced the risk of NACE at 1 year post-PCI (3.9% vs 5.9%; HR 0.66; 95% CI 0.48-0.92)
— cardio-met (@cardiomet_CE) March 5, 2021
JAMA. 2020;323(23):2407-2416. doi:10.1001/jama.2020.7580
30) … Now back to our patient. Based on these recent data, how do you manage this patient?
— cardio-met (@cardiomet_CE) March 5, 2021
a)Keep pt on ASA+Tica for 12m
b)Discontinue Tica now, continue w/ ASA
c)Discontinue ASA now, continue w/ Tica Mono
d)Discontinue ASA in 3 months and continue w/ Tica Mono thereafter
32) Welcome back! You’re almost to your FREE CE/CME from @academiccme.
— cardio-met (@cardiomet_CE) March 6, 2021
34) The 2020 #ESC NSTE-ACS guidelines now support ticagrelor monotherapy after 3m DAPT post-PCI.
— cardio-met (@cardiomet_CE) March 6, 2021
doi:10.1093/eurheartj/ehaa575 pic.twitter.com/uQxGwCNu6B
35) Large randomized trials aiming at investigating ASA-free regimen for other P2Y12 inhibitors are needed.
— cardio-met (@cardiomet_CE) March 6, 2021
36) So you made it! Free CE/CME! Physicians, pharmacists, nurses: go to https://t.co/2e11xEcaFb and claim your credit! I am @drroxmehran. Follow @cardiomet_CE for more tweetorials! #medtwittter #cardiotwitter @MedTweetorials @MedTweetMYHQ
— cardio-met (@cardiomet_CE) March 6, 2021