1) Welcome to a tweetorial on the use of P2Y12 inhibitor monotherapy after PCI! Accredited for 0.50 credits by @academiccme: physicians, nurses, pharmacists! I am @SVRaoMD. pic.twitter.com/RaLLuUZ7gB
— cardio-met (@cardiomet_CE) April 20, 2021
3) 75 yo female presents to the emergency department with 3 days of stuttering angina that was persistent at rest today. PMHx significant for HTN, dyslipidemia, & Type 2 DM.
— cardio-met (@cardiomet_CE) April 20, 2021
5) … The patient is admitted for NSTE-ACS. What is your initial antiplatelet strategy prior to diagnostic angiography?
— cardio-met (@cardiomet_CE) April 20, 2021
7) The PLATO trial (N Engl J Med 2009; 361:1045-1057), with upstream ticag loading, showed a 16% reduction in 1-year death, MI, or stroke with ASA + ticag vs. ASA+ Clopi. Non-CABG related major bleeding in PLATO was higher with ASA + ticag vs. ASA + Clopi (4.5% vs. 3.8%, p=0.03).
— cardio-met (@cardiomet_CE) April 20, 2021
Pre-PCI: pic.twitter.com/9MwGktFEKS
— cardio-met (@cardiomet_CE) April 20, 2021
9) What is the minimum duration for #DAPT for this patient?
— cardio-met (@cardiomet_CE) April 20, 2021
11) Welcome back! I am @SVRaoMD. Choice C is correct. ACC/AHA guidelines give a Class I recommendation to 12 mos of #DAPT for ACS pts who undergo PCI regardless of stent type. They also give a Class IIa to ticagrelor over clopidogrel.
— cardio-met (@cardiomet_CE) April 21, 2021
13) She has been active and feeling well. She wants to know whether she is at high risk for bleeding complications from DAPT. Based on the recent #ARC#HBR criteria (Urban P, et al. Circulation 2019), she has only one criterion for HBR (age): pic.twitter.com/c48xHtjkd4
— cardio-met (@cardiomet_CE) April 21, 2021
15) The #GLOBAL-LEADERS trial (DOI:https://t.co/XjAtXBbuXY) studied ticag w/ ASA for 1m followed by ticag alone for 23m in 15,968 pts post PCI. Ticag alone was not superior to 12m of DAPT followed by 12m of ASA alone at preventing death or MI. But… pic.twitter.com/d0qN3u6RIv
— cardio-met (@cardiomet_CE) April 21, 2021
17) The #SMART-CHOICE trial (doi:10.1001/jama.2019.8146) randomized 2993 pts who underwent PCI to P2Y12 inhibitor monotherapy after 3m of DAPT vs. 12 m of DAPT. P2Y12 mono was non-inferior with respect to death/MI/stroke compared with 12m DAPT. Bleeding was lower with monotherapy
— cardio-met (@cardiomet_CE) April 21, 2021
19) Finally the #TWILIGHT trial (DOI: 10.1056/NEJMoa1908419) led by @drroxmehran randomized 7119 high-risk pts undergoing PCI to ticagrelor monotherapy after 3m of DAPT vs. 12 m DAPT. Ticag monoRx resulted in less bleeding and similar rates of ischemic events.
— cardio-met (@cardiomet_CE) April 21, 2021
21) Based on the available randomized trials, you can counsel the pt that which of the following strategies will reduce bleed risk without compromising ischemic benefit?
— cardio-met (@cardiomet_CE) April 21, 2021
a)ASA+Ticag for 12m
b)ASA+Clopidogrel for 12m
c)Stop ASA at 3m, continue ticag
d)ASA+Prasugrel for 12m
23) Welcome back. You're about to de-escalate #DAPT!
— cardio-met (@cardiomet_CE) April 22, 2021
25) So you made it! Free CE/CME! Physicians, pharmacists, nurses: go to https://t.co/3jXWQOYv2j and claim your credit! I am @SVRaoMD. Follow @cardiomet_CE for more accredited tweetorials! #medtwittter #cardiotwitter
— cardio-met (@cardiomet_CE) April 22, 2021