• Mechanical Valves:
  • Addition of ASA to Vitamin K Antagonists leads to reduction in risk of thromboembolism and mortality compared to VKA therapy alone.
    • (65% observed risk reduction in major systemic embolism or death in the aspirin plus VKA group).The addition of at least 50 to 75 mg/day of aspirin is, therefore, recommended in the current ACC/AHA and ACCP guidelines for all patients with mechanical valves, though consideration must be given to an individual patient's bleeding risk. 
  
  

  Posted 01/31/17 02:01:12 PM by Adam Faye

• TIMI risk Score:
  • Analysis of data from the TIMI 11B and ESSENCE trials found seven variables to be independently predictive of outcome in patients with UA or an NSTEMI. 
    ●Age ≥65 years
    ●Presence of at least three risk factors for coronary heart disease (CHD)
    ●Prior coronary stenosis of ≥50 percent
    ●Presence of ST segment deviation on admission ECG
    ●At least two anginal episodes in prior 24 hours
    ●Elevated serum cardiac biomarkers
    ●Use of ASA in prior seven days 
  
  
  A higher TIMI risk score correlated significantly with increased numbers of events (all-cause mortality, new or recurrent MI, or severe recurrent ischemia requiring revascularization) at 14 days 
  
  
  ●Score of 0/1 – 4.7 percent
  ●Score of 2 – 8.3 percent
  ●Score of 3 – 13.2 percent
  ●Score of 4 – 19.9 percent
  ●Score of 5 – 26.2 percent
  ●Score of 6/7 – 40.9 percent
  
  

  Posted 01/31/17 02:06:19 PM by Adam Faye

• Anti-platelet Agents:
  
  Prasugrel
  13,608 pts with mod-high risk ACS scheduled for PCI; Prasugrel vs. Clopidogrel
  •Primary Endpoint- Death from CV cause
  •12.1% clopidogrel vs. 9.9% prasugrel
  •Reduced in-stent thrombosis
  •Major Bleeding: 2.4% prasugrel vs. 1.8% clopidogrel
  
  Ticagrelor
  18,624 pts admitted with ACS; Ticagrelor vs. Clopidogrel
  •Primary Endpoint- Prevention of CV events
  •11.7% clopidogrel vs. 9.8% ticagrelor
  •No sig. diff in major bleeding – but did have higher risk in fatal intracranial bleeding
  
  Cangrelor
  11,145 pts admitted undergoing PCI: Cangrelor vs. Clopidogrel
  •Primary Endpoint- Death, MI, stent thrombosis at 48hrs
  •Death: 5.9% clopidogrel vs. 4.7% cangrelor
  •Stent Thrombosis: 0.8% cangrelor vs. 1.4% clopidogrel
  •Transient dyspnea more common with Cangrelor
  
  

  Posted 01/31/17 02:28:46 PM by Adam Faye

• IABP:
  600pts. With cardiogenic shock complicating MI planned for PCI – IABP vs. no IABP
  •Primary Outcome – 30-day all-cause mortality
  •39.7% IABP vs. 41.3% no IABP
  •No diff in primary or secondary outcomes
  
  

  Posted 01/31/17 02:30:09 PM by Adam Faye

Created by Christopher Kelly

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