Supported by educational grants from Abbott, AstraZeneca, Bayer, Chiesi, NovoNordisk. This program is intended for healthcare providers.
— cardio-met (@cardiomet_CE) June 1, 2021
3) The patient states that his abd pain has worsened and spread to his chest. He is retching but produces no emesis around his NGT. The cath lab has been activated and the cardiology fellow and a clinical pharmacist quickly arrive at the bedside.
— cardio-met (@cardiomet_CE) June 1, 2021
5) Quick review of his chart confirms several admissions for #Gastroparesis and a cardiac cath 2 years ago that showed diffuse CAD but no stentable lesions. He is now clearly NPO for a reason, as he retches continually and becomes more diaphoretic.
— cardio-met (@cardiomet_CE) June 1, 2021
7) Mark your answer and return tomorrow for more on this case and more education! @Radial_ICG @DrDamluji @kaschenke @mirvatalasnag @ShaziaTHussain1 @mmamas1973 @ShrillaB @DrPeterOKane @cardiojaydoc02 @DrJayMohan @MattersoftheH14
— cardio-met (@cardiomet_CE) June 1, 2021
9) Now re yesterday's poll . . . given the pt's history and current status, PR ASA is acceptable if uncommonly used. The other half of #DAPT, a #P2Y12 inhibitor, is clearly indicated, but the PO route is off limits here, and there is no PR option.
— cardio-met (@cardiomet_CE) June 2, 2021
11) . . . (he’s at fairly high risk, it would seem), then it can always be turned off. And if he doesn’t have surgical anatomy but has a stentable culprit artery, he still won’t be able to take a P2Y12i by mouth in the cath lab.
— cardio-met (@cardiomet_CE) June 2, 2021
13) As #PPCI usually involves deployment of intracoronary #stents (most commonly drug-eluting stents [#DES]), rapid and effective #antiplatelet therapy is required to prevent recurrent MI and acute stent thrombosis.
— cardio-met (@cardiomet_CE) June 2, 2021
15) . . . like esmolol and nitroprusside. It is dosed as a bolus infusion and followed by a drip throughout the procedure. Within 2 to 5 minutes of initiating the bolus, 90-98% platelet inhibition is achieved.
— cardio-met (@cardiomet_CE) June 2, 2021
17) So this patient has severe diabetic #Gastroparesis, but we may see delayed gastric emptying and therefore delay of #antiplatelet effect from ticagrelor in ANY patient with STEMI, where time is muscle, for other reasons. Why?
— cardio-met (@cardiomet_CE) June 2, 2021
19) Welcome back! You are just a few clicks away from free #CME/CE. We are talking #antiplatelets in #STEMI when the patient is NPO, in this case from #Gastroparesis. I am @md_pollack and this program is accredited by @academiccme.
— cardio-met (@cardiomet_CE) June 3, 2021
21) It's worth pointing out that this pt's DM contributes to that immed need for P2Y12 inhibition. It is well understood that #platelets in DM exhibit increased reactivity, from dysregulation of several signaling pathways by hyperglycemia, insulin resistance, and inflammation.
— cardio-met (@cardiomet_CE) June 3, 2021
23) He still had diffuse CAD, slightly worse than last cath, but had total occlusion of the proximal RCA, which was successfully stented with restoration of TIMI 3 flow. The clinical #pharmacist suggested turning off the suction on the NGT and giving 180mg ticagrelor crushed.
— cardio-met (@cardiomet_CE) June 3, 2021
25) The remaining question was how long to continue the cangrelor infusion, given this pt's #Gastroparesis. No real literature guidance here. Our friend #DominckAngiolillo has written (Circulation. 2017;136:1955–1975) that the FDA indicates that
— cardio-met (@cardiomet_CE) June 3, 2021
ticagrelor can . . .
27) Dr Angiolillo et al recommend that earlier administration of ticagrelor (eg, at the time of
— cardio-met (@cardiomet_CE) June 3, 2021
PCI) should be considered over administration at the
end of cangrelor infusion because it would minimize
the potential gap in platelet inhibition during the transition phase.
29) Prior to d/c on 81mg ASA and 90mg ticagrelor BID, he was enrolled by GI into a new trial for diabetic #Gastroparesis, and it was anticipated that he might be a candidate for elective CABG soon. For now, the early initiation of IV #P2Y12i transitioned to oral was successful.
— cardio-met (@cardiomet_CE) June 3, 2021
31) Cangrelor is not a prodrug, and is rapid onset AND offset. Like ticagrelor, it is a reversible P2Y12 inhibitor. A recent review of its use is at https://t.co/SMat9XrchI. Good job by @MonilMajmundar.
— cardio-met (@cardiomet_CE) June 3, 2021
33) That's it! You made it! Free CE/CME! Now, all you #physicians, #nurses, and #pharmacists, go to https://t.co/YMbiuaLKFS and claim your credit from @academiccme! I am @md_pollack. Follow @cardiomet_CE for more tweetorials! #medtwittter #cardiotwitter @MedTweetorials
— cardio-met (@cardiomet_CE) June 3, 2021