Pearls from Dr. Sahil Parikh
- 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
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% clopidogrelTicagrelor
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 bleedingCangrelor
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
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
For further reading...
Posted 10/10/17 10:51:41 AM by Kaylan Christianer
For further reading...
Posted 10/10/17 10:52:16 AM by Kaylan Christianer
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