Cath Lab – Issues DuringInterventionIssues confronting the cardiologist :• Damaged endothelial cells during  balloon angio...
Release of ADP and TxA2
Activation of Platelet Receptors
Cath Lab – Issues DuringInterventionIssues confronting the cardiologist :• Adequate enzymatic anticoagulation and  antipla...
Targeted Receptor Inhibition
Ischemic Risk StratificationColumbia Study      Sinai Study (Non-cardiac        (Cath lab)   surgical)
Aspirin Monitoring with TEG®Analysis
Plavix Monitoring with TEG®Analysis
TEG® IndividualizedMaintenance Regimen
Resistance to Aspirin andPlavix Prior to InterventionFor the cardiologist in the Cath Lab: Heworries about resistance – bu...
Pre-Intervention Protocol
Cath Lab – Issues Post           Intervention          Recurrent Rate of Ischemic Events                                  ...
Cath Lab – Issues PostInterventionCardiologist needs post intervention:• Determine total platelet function• Provide guidan...
TEG Analysis withPlateletMapping™• Determine total platelet function• Provide guidance in maintenance  antiplatelet therap...
Transition Protocol
Maintenance Protocol
Resistance to Aspirin andPlavix Market
Summary• TEG analysis addresses hemostasis  issues in both intervention and  maintenance phases• TEG measures total platel...
Case Studies
Patient A• 600mg Plavix® (approx. 1 hour after load)• MAP2: 51.4• %MA reduction: 4.9
Patient A• 600mg Plavix® (approx. 2 hours after load)• MAP2: 42.8• %MA reduction: 47.8
Patient B• 325mg aspirin + Integrilin®• MAP3: 17.8• %MA reduction: 100
Patient C• Angiomax® + Integrilin®• MAP2: 11.6• %MA reduction: 100
Patient C• Angiomax® + Integrilin®• MAP3: 8.5• %MA reduction: 100
Patient D• 325mg aspirin + unknown drug• MAP3: 15.3• %MA reduction: 98.5
TEG® AnalyzerModel 5000
Connectivity
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Teg cath lab,plateletmapping

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  • The orange (outer) tracing shows MA with citrated kaolin. The pink (outer) tracing shows MA with arachidonic acid before platelet inhibition with aspirin. The white (inner) tracing shows MA with arachidonic acid after platelet inhibition with aspirin. The green (inner) tracing shows MA attributed to fibrinogen alone.
  • The orange (outermost) tracing shows MA with kaolin and heparinase. The white (outer middle) tracing shows MA before platelet inhibition with Plavix ® . The green (inner middle) tracing shows platelet inhibition with Plavix ® . The pink (innermost) tracing shows MA attributed to fibrinogen alone.
  • The new TEG® model 5000 differs from the previous TEG® models in that it is ergonomically designed, and it is easy to use and maintain. There is a temperature sensor and heating element attached to each cup carrier holding the blood sample, providing the capability of setting each blood sample to a different temperature to measure the effects of hypothermia. It provides an automatic disposable cup and pin ejection mechanism to protect the operator from blood contact.  
  • Teg cath lab,plateletmapping

    1. 1. Cath Lab – Issues DuringInterventionIssues confronting the cardiologist :• Damaged endothelial cells during balloon angioplasty• Exposure of TF to the bloodstream• Exposure of stent surfaces to the blood stream• Explosion of enzymatic and platelet activation• Extreme prothrombotic state
    2. 2. Release of ADP and TxA2
    3. 3. Activation of Platelet Receptors
    4. 4. Cath Lab – Issues DuringInterventionIssues confronting the cardiologist :• Adequate enzymatic anticoagulation and antiplatelet therapy• Extent of inhibition by Aspirin or Plavix• Does the patient need GPII/IIIa inhibitor drugs?
    5. 5. Targeted Receptor Inhibition
    6. 6. Ischemic Risk StratificationColumbia Study Sinai Study (Non-cardiac (Cath lab) surgical)
    7. 7. Aspirin Monitoring with TEG®Analysis
    8. 8. Plavix Monitoring with TEG®Analysis
    9. 9. TEG® IndividualizedMaintenance Regimen
    10. 10. Resistance to Aspirin andPlavix Prior to InterventionFor the cardiologist in the Cath Lab: Heworries about resistance – but is it evenneeded?The TEG® system can:• Identify resistance to therapy• Determine if therapy is being given at a therapeutic level• Determine if the patient will need GPIIb/IIIa inhibition during intervention
    11. 11. Pre-Intervention Protocol
    12. 12. Cath Lab – Issues Post Intervention Recurrent Rate of Ischemic Events PCI-TABLE 1 CURE CREDO CURE Placebo (%) 11.4 12.6 11.5Percent recurrence ASA Onlyof ischemia Study (%) 9.3 8.8 8.5 ASA + PlavixReduction inrecurrence of Absolute (%) 2.1 3.8 3.0ischemia
    13. 13. Cath Lab – Issues PostInterventionCardiologist needs post intervention:• Determine total platelet function• Provide guidance in antiplatelet therapy• Measure the effect of platelet inhibiting drugsThe TEG® system addresses these issuesand individualizes the maintenanceregimen post intervention.
    14. 14. TEG Analysis withPlateletMapping™• Determine total platelet function• Provide guidance in maintenance antiplatelet therapy  Identify who needs it  Determine level of inhibition needed  Assess therapeutic level and/or resistance
    15. 15. Transition Protocol
    16. 16. Maintenance Protocol
    17. 17. Resistance to Aspirin andPlavix Market
    18. 18. Summary• TEG analysis addresses hemostasis issues in both intervention and maintenance phases• TEG measures total platelet function as well as inhibition levels of primary receptors• TEG determines therapeutic levels• TEG analysis with PlateletMapping enables personalized antiplatelet therapy management
    19. 19. Case Studies
    20. 20. Patient A• 600mg Plavix® (approx. 1 hour after load)• MAP2: 51.4• %MA reduction: 4.9
    21. 21. Patient A• 600mg Plavix® (approx. 2 hours after load)• MAP2: 42.8• %MA reduction: 47.8
    22. 22. Patient B• 325mg aspirin + Integrilin®• MAP3: 17.8• %MA reduction: 100
    23. 23. Patient C• Angiomax® + Integrilin®• MAP2: 11.6• %MA reduction: 100
    24. 24. Patient C• Angiomax® + Integrilin®• MAP3: 8.5• %MA reduction: 100
    25. 25. Patient D• 325mg aspirin + unknown drug• MAP3: 15.3• %MA reduction: 98.5
    26. 26. TEG® AnalyzerModel 5000
    27. 27. Connectivity

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