This study compared the platelet inhibitor ticagrelor to clopidogrel in 18,624 patients with acute coronary syndrome, with or without ST elevation. At 12 months, the primary endpoint of death from vascular causes, myocardial infarction or stroke occurred in 9.8% of patients on ticagrelor vs 11.7% on clopidogrel, showing ticagrelor was more effective. Ticagrelor also reduced death from any cause and myocardial infarction alone, but increased non-procedure related bleeding including fatal intracranial bleeding. Overall major bleeding was similar between groups. The study demonstrates ticagrelor reduces ischemic events compared to clopidogrel in acute coronary syndrome patients without increasing major bleeding risk.
Dual antiplatelet therapy has long been the standard of care in preventing coronary and cerebrovascular thrombotic events in patients
with chronic coronary syndrome and acute coronary syndrome undergoing percutaneous coronary intervention, but choosing the optimal
treatment duration and composition has become a major challenge. Numerous studies have shown that certain patients benefit from ei ther shortened or extended treatment duration. Furthermore, trials evaluating novel antithrombotic strategies, such as P2Y12 inhibitor
monotherapy, low-dose factor Xa inhibitors on top of antiplatelet therapy, and platelet function- or genotype-guided (de-)escalation of
treatment, have shown promising results. Current guidelines recommend risk stratification for tailoring treatment duration and composition. Although several risk stratification methods evaluating ischaemic and bleeding risk are available to clinicians, such as the use of risk
scores, platelet function testing , and genotyping, risk stratification has not been broadly adopted in clinical practice. Multiple risk scores
have been developed to determine the optimal treatment duration, but external validation studies have yielded conflicting results in terms
of calibration and discrimination and there is limited evidence that their adoption improves clinical outcomes. Likewise, platelet function
testing and genotyping can provide useful prognostic insights, but trials evaluating treatment strategies guided by these stratification methods have produced mixed results. This review critically appraises the currently available antithrombotic strategies and provides a viewpoint
on the use of different risk stratification methods alongside clinical judgement in current clinical practice.
A ruptured or eroded coronary atherosclerotic plaque is the principal underlying cause of an acute coronary syndrome. The greatest ‘at risk’ period is during this early phase of plaque instability and healing, with recurrent event rates peaking in the first month. By 3 months, the plaque has usually
stabilised, healed and subsequent event rates return
to the background rates seen in patients with stable
coronary heart disease.1–3 Indeed, beyond 3 months,
recurrent events commonly occur on plaques at
other sites within the coronary circulation.3 From
first principles, the first 3 months is the most critical
time for interventions to reduce recurrent cardiovascular
events after an acute coronary syndrome
(ACS). This is consistent with event rates seen in
all clinical trials of patients with acute coronary syndrome: an initial time-varying high event rate that reverts to a consistent linear lower event rate from 3 months onwards
Dual antiplatelet therapy has long been the standard of care in preventing coronary and cerebrovascular thrombotic events in patients
with chronic coronary syndrome and acute coronary syndrome undergoing percutaneous coronary intervention, but choosing the optimal
treatment duration and composition has become a major challenge. Numerous studies have shown that certain patients benefit from ei ther shortened or extended treatment duration. Furthermore, trials evaluating novel antithrombotic strategies, such as P2Y12 inhibitor
monotherapy, low-dose factor Xa inhibitors on top of antiplatelet therapy, and platelet function- or genotype-guided (de-)escalation of
treatment, have shown promising results. Current guidelines recommend risk stratification for tailoring treatment duration and composition. Although several risk stratification methods evaluating ischaemic and bleeding risk are available to clinicians, such as the use of risk
scores, platelet function testing , and genotyping, risk stratification has not been broadly adopted in clinical practice. Multiple risk scores
have been developed to determine the optimal treatment duration, but external validation studies have yielded conflicting results in terms
of calibration and discrimination and there is limited evidence that their adoption improves clinical outcomes. Likewise, platelet function
testing and genotyping can provide useful prognostic insights, but trials evaluating treatment strategies guided by these stratification methods have produced mixed results. This review critically appraises the currently available antithrombotic strategies and provides a viewpoint
on the use of different risk stratification methods alongside clinical judgement in current clinical practice.
A ruptured or eroded coronary atherosclerotic plaque is the principal underlying cause of an acute coronary syndrome. The greatest ‘at risk’ period is during this early phase of plaque instability and healing, with recurrent event rates peaking in the first month. By 3 months, the plaque has usually
stabilised, healed and subsequent event rates return
to the background rates seen in patients with stable
coronary heart disease.1–3 Indeed, beyond 3 months,
recurrent events commonly occur on plaques at
other sites within the coronary circulation.3 From
first principles, the first 3 months is the most critical
time for interventions to reduce recurrent cardiovascular
events after an acute coronary syndrome
(ACS). This is consistent with event rates seen in
all clinical trials of patients with acute coronary syndrome: an initial time-varying high event rate that reverts to a consistent linear lower event rate from 3 months onwards
Dual antiplatelet therapy (DAPT) with aspirin (ASA) and a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel) is a standard therapeutic regimen to prevent stent thrombosis after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). The duration of DAPT has significant risk/benefit consequences and implications on quality improvement and patient safety. Since the last American College of Cardiology (ACC) and American Heart Association (AHA) PCI DAPT Guidelines were published in 2016,1 there has been an explosion of data regarding strategies to shorten the duration of DAPT. This Tip of the Month (TOTM) will place perspective on the most recent studies in comparison with the older guidelines—but with advice to address the current demands of contemporary decision processes.
DANISH is a major breakthrough trial published in NEJM on 29/09/2016 regarding Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. All content of this slide is Copy right of NEJM.
La Dra. Silvia Valbuena López repasa los resultados del estudio con ticagrelor y prasugrel en pacientes con síndrome coronario agudo, presentado en ESC Congress 2019.
Dual antiplatelet therapy (DAPT) with aspirin (ASA) and a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel) is a standard therapeutic regimen to prevent stent thrombosis after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). The duration of DAPT has significant risk/benefit consequences and implications on quality improvement and patient safety. Since the last American College of Cardiology (ACC) and American Heart Association (AHA) PCI DAPT Guidelines were published in 2016,1 there has been an explosion of data regarding strategies to shorten the duration of DAPT. This Tip of the Month (TOTM) will place perspective on the most recent studies in comparison with the older guidelines—but with advice to address the current demands of contemporary decision processes.
DANISH is a major breakthrough trial published in NEJM on 29/09/2016 regarding Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. All content of this slide is Copy right of NEJM.
La Dra. Silvia Valbuena López repasa los resultados del estudio con ticagrelor y prasugrel en pacientes con síndrome coronario agudo, presentado en ESC Congress 2019.
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
Journal Article Analysis: Ticagrelor versus Clopidogrel in ACS (PLATO)Paul Pasco
A journal article analysis ("journal club") I composed of a notable clinical trial during an internship/Advanced Pharmacy Practice Experience (APPE) in a community pharmacy at a hospital.
Bleeding complications in secondary stroke prevention by antiplatelet therapy...Duwan Arismendy
Abstract
Abstract. Boysen G (University of Copenhagen, Copenhagen, Denmark). Bleeding complications in secondary stroke prevention by antiplatelet therapy: a benefit–risk analysis (Review). J Intern Med 1999; 246: 239–245.
This review analyses the benefit–risk ratio of antiplatelet drugs in secondary stroke prevention and is based on the published data from eight large stroke prevention trials. In patients with prior transient ischaemic attack (TIA) or stroke, aspirin prevented one to two vascular events (stroke, AMI, or vascular death) per 100 treatment-years with an excess risk of fatal and severe bleeds of 0.4–0.6 per 100 treatment-years. The gastrointestinal bleeding risk was significantly lower with ticlopidine and clopidogrel, which were both somewhat more effective than aspirin in the prevention of vascular events. The combination of dipyridamole and aspirin prevented 2.82 strokes at the expense of an excess risk of 0.61 (95% CI = 0.27–0.95) fatal or severe bleeds per 100 treatment-years.
In the acute phase of stroke, the aspirin-associated risk of haemorrhagic complications was much increased compared with that in the stable phase after stroke, with 0.48 (95% CI = 0.13–0.83) fatal or severe bleeds per 100 treated patients for the first 4 weeks after stroke in the Chinese Acute Stroke Trial and 0.41 (95% CI = 0.05–0.77) in the International Stroke Trial. Still, there was a net benefit with the prevention of about one death or non-fatal ischaemic stroke per 100 treated patients.
ESC 2012 research highlights: A slideshow presentationtheheart.org
The European Society of Cardiology (ESC) 2012 Congress took place in Munich, Germany from August 25 through August 29, 2012. Key trials presented at the sessions include: WOEST, ALTITUDE, FAME II, TRILOGY ACS, ACCESS EU,PURE, GARY. IABP SHOCK II, PARAMOUNT and DeFACTO
Stroke IV thrombolysis beyond limitations; case series and review of literatureApollo Hospitals
Thrombolytic therapy is the only available medical treatment for acute ischemic stroke that has been proven to be effective. Intravenously administered recombinant tissue plasminogen activator (rtPA) has been shown to improve the long-term functional outcome and is recommended for the treatment of eligible acute stroke patients. However, due to the risk of major bleeding, particularly in the brain, patients need to be carefully selected on the basis of eligibility criteria. These have
been largely adopted from the inclusion and exclusion criteria used in the randomized clinical trials.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.