Watch here tomorrow a new accredited, serialized tweetorial on optimizing duration of antiplatelet therapy after ACS/PCI. Earn 0.5 CE/#CME credits: #physicians, #nurses, #pharmacists! Expert faculty @mirvatalasnag. #medtwitter @academiccme #cardiotwitter #FOAMed @CardioNerds
— cardio-met (@cardiomet_CE) August 2, 2021
2) This series is supported by educational grants from AstraZeneca, Bayer, Chiesi, and NovoNordisk and is intended for healthcare providers. Faculty disclosures are listed at https://t.co/gvXca4G9Xm.
— cardio-met (@cardiomet_CE) August 3, 2021
Now let's start with a case!
3) Case summary: 85y woman with history of GI bleeding secondary to peptic ulcer disease 3 months ago, is admitted with an NSTEMI. She is hemodynamically stable and her baseline Hb is 10 g/dl. pic.twitter.com/zbvpmmuAhv
— cardio-met (@cardiomet_CE) August 3, 2021
5) Since the patient is hemodynamically stable with TIMI III flow in her epicardial coronary arteries, we do not proceed with ad hoc PCI & opt to discuss options at the heart team meeting. What would you recommend as a revascularization option in this 85 year old?
— cardio-met (@cardiomet_CE) August 3, 2021
6) At the heart team meeting, we agreed to proceed with an endoscopy to determine her risk for a future bleed. It revealed a healing duodenal ulcer and no active bleeding. As such, given her age and frailty, she was deemed too high risk for CABG & complex PCI was offered.
— cardio-met (@cardiomet_CE) August 3, 2021
8) Her bleeding risk stems from age, anemia and prior bleeding. The decision to initiate DAPT and its duration needs to jointly evaluate and balance ischemic and bleeding risks. @AHAScience @escardio @ACCinTouch @SVRaoMD @DLBHATTMD @DrMauricioCohen @DocSavageTJU @JJheart_doc pic.twitter.com/sJPJ4foxWl
— cardio-met (@cardiomet_CE) August 3, 2021
9) With a bifurcation strategy for an #ACS, what is the ideal #DAPT duration in this case?
— cardio-met (@cardiomet_CE) August 3, 2021
11) Welcome back! I am @mirvatalasnag and we are back to discuss #DAPT in pts with #HBR. You have found the web's ONLY source of accredited tweetorials in #cardiometabolic medicine. Welcome #physicians, #nurses, #pharmacists! Welcome #PAs and #NPs!
— cardio-met (@cardiomet_CE) August 4, 2021
13) . . . before PCI (Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition [CHAMPION] PCI, N Engl J Med 2009; 361:2318-2329, @heartbobh) or after PCI (CHAMPION PLATFORM, N Engl J Med 2009; 361:2330-2341, @DLBHATTMD)
— cardio-met (@cardiomet_CE) August 4, 2021
15) A meta-analysis demonstrated a benefit for major ischaemic endpoints counter-balanced by an increase in minor bleeding. pic.twitter.com/pBb3JLs4rr
— cardio-met (@cardiomet_CE) August 4, 2021
17) The guidelines distinguish between ACS and non-ACS cases: @escardio @ACCinTouch
— cardio-met (@cardiomet_CE) August 4, 2021
If the patient has an ACS and the ischemic risk is high with a low bleeding risk, the ideal duration would be 12 months. pic.twitter.com/a0Ee4QMsWk
19) IVUS-guided PCI has been reported to reduce TVF 12m after PCI compared to angio-guided PCI in the Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All-Comers” Coronary Lesions (ULTIMATE) randomized trial:
— cardio-met (@cardiomet_CE) August 4, 2021
21) However, only 12% of the enrolled pts presented with STEMI or NSTE-ACS, limiting its validity in NSTE-ACS settings.https://t.co/wsKLbreX25 pic.twitter.com/UgbGlZDwYp
— cardio-met (@cardiomet_CE) August 4, 2021
23) . . . confirming noninferiority and superiority for net adverse clinical events (ischemia + bleeding) compared with 12m #DAPT.
— cardio-met (@cardiomet_CE) August 4, 2021
https://doi:10.1001/jama.2019.8145
25) In both IVUS was used > 90% of cases; however, these were low risk Asian populations and majority were not ACS cases. As such, the cohort cannot be used to represent all populations with ACS. STOPDAPT-2 ACS will be released soon @pcronlinehttps://t.co/nbsCrh4AL6
— cardio-met (@cardiomet_CE) August 4, 2021
— cardio-met (@cardiomet_CE) August 4, 2021
28) Mark your answer and return tomorrow for case wrap-up, more education, and a link to your CE/#CME credit! @HanCardiomd @abdellateefMohm @SanChris999 @HenrytTimothy @yourheartdoc1 @SuzanneJBaron @YMurasato @susannaprice @md_arianemacedo @KAlaswadMD @mornei2011 @KateKearney4 pic.twitter.com/nXdYQKjGjG
— cardio-met (@cardiomet_CE) August 4, 2021
30) The trials evaluating the role of OAC & DAPT (triple therapy) are summarized here: pic.twitter.com/I2RB29Fu9v
— cardio-met (@cardiomet_CE) August 5, 2021
32) So you made it! Free CE/#CME! Special nods to @djc795 @cpgale3 @JSillerMatula @thiele_holger @SVRaoMD @hect2701 @duanepinto @rcstoler @vass_vassiliou @sbrugaletta @Ortega_Paz @Costa_F_8 @Saia_fracesco
— cardio-met (@cardiomet_CE) August 5, 2021
33) Now, #physicians, #pharmacists, #nurses: go to https://t.co/48zJxwGBz2 and claim your credit! I am @mirvatalasnag. Follow @cardiomet_CE for more accredited tweetorials! #medtwittter #cardiotwitter @MedTweetorials @AAPAorg pic.twitter.com/Z8uPjyp1lZ
— cardio-met (@cardiomet_CE) August 5, 2021