1) Welcome to a #tweetorial on #DAPT in patients with stable CAD+#diabetes who have not had an MI or stroke. Accredited for 0.5h by @academiccme: #physicians, #nurses, #pharmacists! I am @gabrielsteg . . .
— cardio-met (@cardiomet_CE) June 22, 2021
2) This is a Journal Club on The Effect of Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study (THEMIS) primary pub, found at https://t.co/xOBkPsODwy. (We also discuss elements of THEMIS-PCI (Lancet 2019 394(10204):1169-1180)). pic.twitter.com/5XGxmcwR2z
— cardio-met (@cardiomet_CE) June 22, 2021
4) First, a poll: in which of these populations has ticagrelor+ASA been shown to provide a net clinical benefit over ASA alone?
— cardio-met (@cardiomet_CE) June 22, 2021
6) Part of that risk derives from increased #platelet activation in diabetics (Circulation 2011;123:798-813).
— cardio-met (@cardiomet_CE) June 22, 2021
8) Therefore, ASA alone, the standard therapy in patients who have not yet had a primary event, may not provide fully effective antithrombotic protection.
— cardio-met (@cardiomet_CE) June 22, 2021
10) And so in THEMIS we tested whether patients with diabetes and stable coronary artery disease without a history of prior MI or stroke derived benefit from dual antiplatelet therapy with aspirin and ticagrelor
— cardio-met (@cardiomet_CE) June 22, 2021
12) THEMIS eventually randomized 19220 patients, median age 66, 31% female, 62% had a history of MVD, 80% a history of coronary revascularization (58% PCI, 22% CABG), mean duration of diabetes was 10 years, and >99% were on aspirin.
— cardio-met (@cardiomet_CE) June 22, 2021
14) The correct answer is 7.6% at 3 years. Ticagrelor reduced the primary outcome by 10% (95% CI 0.81–0.99) P=0.038 (N Engl J Med 2019; 381:1309-1320). pic.twitter.com/X7vD5TIAYz
— cardio-met (@cardiomet_CE) June 22, 2021
16) Safety outcomes showed ticagrelor increased the risk of bleeding, with a greater increase in patients without a history of PCI pic.twitter.com/bv7VAmZcRt
— cardio-met (@cardiomet_CE) June 22, 2021
18) Before we leave, let’s review today’s data. In THEMIS, the net clinical benefit (defined as the composite of death, MI, stroke, fatal bleed or ICH) of ticagrelor in patients with a history of PCI was reduced by
— cardio-met (@cardiomet_CE) June 22, 2021
20) Welcome back to this Journal Club on the #THEMIS study! I am @gabrielsteg and I am happy you found the ONLY source for serialized accredited #tweetorials in #cardiometabolic care! @HeartBobH @GruentzigG @AnkurKalraMD @cpgale3 @atulpathak31 @fjpinto1960 @pamelasdouglas pic.twitter.com/dMFqEFSBoH
— cardio-met (@cardiomet_CE) June 23, 2021
22) In patients with a history of PCI, the benefit of ticagrelor over placebo on reduction of CV death, MI or stroke, appeared to be present for several years after the index PCI pic.twitter.com/M4Pjoae2Gm
— cardio-met (@cardiomet_CE) June 23, 2021
24) Because of the high d/c rates, on-treatment analyses can be informative (but can overestimate treatment efficacy)
— cardio-met (@cardiomet_CE) June 23, 2021
The on-treatment analysis of THEMIS suggested a more marked reduction of the primary outcome in excess of 25% in the subgroup of patients with history of PCI. pic.twitter.com/pVg7MijXO2
26) The main THEMIS PCI findings can be summarized as follows: in patients with prior history of PCI, ticagrelor was as effective as in the overall trial, but safety was better and therefore ticagrelor+ASA produced a 15% net clinical benefit
— cardio-met (@cardiomet_CE) June 23, 2021
28) State your position and return tomorrow for a wrap-up and a link to FREE CE/#CME ! Poke @DavidLBrownMD @radcliffeCARDIO @BorregaardBritt @AgewallStefan @DrM_ODonoghue @aayshacader @mirvatalasnag @cardio73 @biljana_parapid @DrMarthaGulati @ShrillaB @Ortega_Paz @SripalBangalore
— cardio-met (@cardiomet_CE) June 23, 2021
30) The majority of you indicated that your current antiplatelet management of patients with stable CAD and diabetes (no prior MI or stroke) is ASA alone. While that was standard practice prior to the THEMIS/THEMIS-PCI data . . .
— cardio-met (@cardiomet_CE) June 24, 2021
32) There is of course overlap in the risk factors for ischemic and hemorrhagic complications, but this is such a high-risk population that you should consider the balance between the two, especially in patients who have had #PCI.
— cardio-met (@cardiomet_CE) June 24, 2021
33) That's it! You made it! Free CE/#CME! #Physicians, #nurses, #pharmacists: go to https://t.co/YKB2fsUdLT and claim your credit! I am @gabrielsteg. Follow us for more tweetorials! #Medtwitter #MedEd #cardiotwitter @MedTweetorials @CardioOnline @SFCardio @radcliffeCARDIO
— cardio-met (@cardiomet_CE) June 24, 2021