The document summarizes information about antiplatelet drugs, including their definition, mechanism of action, role in different diseases, and major clinical trials. Antiplatelet drugs prevent and inhibit platelet activation and aggregation to interfere with thrombus formation. The principal classes are cyclooxygenase inhibitors like aspirin, and P2Y12 receptor blockers that inhibit the ADP pathway such as clopidogrel, prasugrel, and ticagrelor. Major trials like CAPRIE, CHARISMA, and Prevention of Cardiovascular Events compared antiplatelet regimens in coronary diseases and found some regimens reduced events more than aspirin alone with increased bleeding risks. Optimal medical therapy alone was found sufficient
This document summarizes a study comparing long-term outcomes of clopidogrel versus aspirin monotherapy after percutaneous coronary intervention (PCI). The study included over 5,400 patients who received dual antiplatelet therapy for 6-18 months after PCI. Patients were then randomized to clopidogrel or aspirin monotherapy. After a median follow up of 5.8 years, the primary endpoint occurred in 12.8% of clopidogrel patients and 16.9% of aspirin patients, showing clopidogrel reduced risk. Secondary endpoints including thrombosis and bleeding were also lower with clopidogrel. The study concludes clopidogrel provides significant relative risk reduction compared to aspirin for long-term
This document discusses antiplatelet therapies and summarizes several studies on their use. It provides guidelines for antiplatelet treatment in different clinical scenarios, such as acute coronary syndrome or stent placement. It also discusses controversies around restarting aspirin after intracerebral hemorrhage and managing dual antiplatelet therapy following a bleed. The document emphasizes the need to balance bleeding risks against risks of stent thrombosis.
The document discusses the antiplatelet drug Prasugrel. It is a newer generation thienopyridine that irreversibly inhibits the P2Y12 receptor on platelets, more potently than Clopidogrel. Studies like TRITON-TIMI 38 found Prasugrel reduced cardiovascular events compared to Clopidogrel in ACS patients undergoing PCI, though with increased bleeding risk. The TRILOGY trial found no difference in outcomes between Prasugrel and Clopidogrel in high-risk NSTEMI/UA patients managed medically. The PRAGUE-18 study showed similar efficacy and bleeding for Prasugrel and Ticagrelor in STEMI patients treated with primary PCI.
Ticagrelor is a reversible P2Y12 inhibitor that was developed to overcome limitations of clopidogrel such as variable metabolism and slow onset of action. The PLATO trial found ticagrelor to be superior to clopidogrel in reducing cardiovascular events in ACS patients with no increase in major bleeding. The PEGASUS trial found ticagrelor reduced cardiovascular events in stable patients with prior MI compared to placebo on aspirin. However, the EUCLID trial found ticagrelor was no better than clopidogrel in reducing events in PAD patients and increased dyspnea. The TREAT trial is investigating ticagrelor vs clopidogrel after fibrinolytic therapy in STE
Ticagrelor is an oral, reversible P2Y12 platelet inhibitor that was developed to overcome limitations of clopidogrel such as its requirement for metabolic activation, slow onset of action, and inter-individual variability. The PLATO trial found ticagrelor to be superior to clopidogrel in reducing cardiovascular events in acute coronary syndrome patients with no significant difference in major bleeding. The PEGASUS-TIMI 54 trial found ticagrelor added to aspirin reduced cardiovascular events in stable patients with prior myocardial infarction compared to placebo plus aspirin, with increased risk of major bleeding. The EUCLID trial found ticagrelor was not superior to clopidogrel for reducing cardiovascular events in
Drugs for prophylaxis of Myocardial InfarctionJervinM
Drugs for prophylaxis of Myocardial Infarction
Myocardial Infarction
Drugs for primary prevention of MI
Drugs for secondary prevention of MI
Recent advances
Cardiac rehabilitation
This document summarizes a study comparing long-term outcomes of clopidogrel versus aspirin monotherapy after percutaneous coronary intervention (PCI). The study included over 5,400 patients who received dual antiplatelet therapy for 6-18 months after PCI. Patients were then randomized to clopidogrel or aspirin monotherapy. After a median follow up of 5.8 years, the primary endpoint occurred in 12.8% of clopidogrel patients and 16.9% of aspirin patients, showing clopidogrel reduced risk. Secondary endpoints including thrombosis and bleeding were also lower with clopidogrel. The study concludes clopidogrel provides significant relative risk reduction compared to aspirin for long-term
This document discusses antiplatelet therapies and summarizes several studies on their use. It provides guidelines for antiplatelet treatment in different clinical scenarios, such as acute coronary syndrome or stent placement. It also discusses controversies around restarting aspirin after intracerebral hemorrhage and managing dual antiplatelet therapy following a bleed. The document emphasizes the need to balance bleeding risks against risks of stent thrombosis.
The document discusses the antiplatelet drug Prasugrel. It is a newer generation thienopyridine that irreversibly inhibits the P2Y12 receptor on platelets, more potently than Clopidogrel. Studies like TRITON-TIMI 38 found Prasugrel reduced cardiovascular events compared to Clopidogrel in ACS patients undergoing PCI, though with increased bleeding risk. The TRILOGY trial found no difference in outcomes between Prasugrel and Clopidogrel in high-risk NSTEMI/UA patients managed medically. The PRAGUE-18 study showed similar efficacy and bleeding for Prasugrel and Ticagrelor in STEMI patients treated with primary PCI.
Ticagrelor is a reversible P2Y12 inhibitor that was developed to overcome limitations of clopidogrel such as variable metabolism and slow onset of action. The PLATO trial found ticagrelor to be superior to clopidogrel in reducing cardiovascular events in ACS patients with no increase in major bleeding. The PEGASUS trial found ticagrelor reduced cardiovascular events in stable patients with prior MI compared to placebo on aspirin. However, the EUCLID trial found ticagrelor was no better than clopidogrel in reducing events in PAD patients and increased dyspnea. The TREAT trial is investigating ticagrelor vs clopidogrel after fibrinolytic therapy in STE
Ticagrelor is an oral, reversible P2Y12 platelet inhibitor that was developed to overcome limitations of clopidogrel such as its requirement for metabolic activation, slow onset of action, and inter-individual variability. The PLATO trial found ticagrelor to be superior to clopidogrel in reducing cardiovascular events in acute coronary syndrome patients with no significant difference in major bleeding. The PEGASUS-TIMI 54 trial found ticagrelor added to aspirin reduced cardiovascular events in stable patients with prior myocardial infarction compared to placebo plus aspirin, with increased risk of major bleeding. The EUCLID trial found ticagrelor was not superior to clopidogrel for reducing cardiovascular events in
Drugs for prophylaxis of Myocardial InfarctionJervinM
Drugs for prophylaxis of Myocardial Infarction
Myocardial Infarction
Drugs for primary prevention of MI
Drugs for secondary prevention of MI
Recent advances
Cardiac rehabilitation
- The document discusses secondary prevention of ischemic stroke through the use of antiplatelet agents such as aspirin, ticlopidine, and clopidogrel. These antiplatelet agents provide a modest reduction in risk of non-fatal stroke and death.
- While antiplatelet therapy is effective, more effective and safe treatment options are still needed given the devastating consequences of stroke.
- Acceptable options for initial antiplatelet therapy include aspirin, clopidogrel, ticlopidine, and the combination of aspirin and dipyridamole. Clopidogrel is preferred over ticlopidine due to fewer side effects.
The TWILIGHT trial compared ticagrelor monotherapy to ticagrelor plus aspirin in patients at high risk of bleeding and ischemic events after PCI. Over 7,000 patients received ticagrelor and aspirin for 3 months after PCI. Then patients were randomized to ticagrelor alone or with aspirin for 12 more months. The study found ticagrelor monotherapy was associated with a 44% lower risk of bleeding over 1 year without increasing ischemic events, suggesting it may be a safer option for high risk patients after a brief initial period of dual antiplatelet therapy.
The document discusses various clinical trials related to cardiovascular diseases. It summarizes the ACCORD BP study which found that targeting a SBP of <120 mm Hg compared to <140 mm Hg in patients with type 2 diabetes did not reduce cardiovascular events. It also summarizes the HOPE trial which found that ramipril reduced cardiovascular deaths, myocardial infarction, and stroke in high-risk patients without low ejection fraction or heart failure. Finally, it summarizes the EUROPA trial which found that perindopril reduced the primary endpoint of cardiovascular mortality, non-fatal MI, and cardiac arrest in patients with stable coronary artery disease.
1. A study found that early treatment of a first episode of acute pericarditis with colchicine in addition to standard anti-inflammatory therapy reduced the risk of recurrence compared to anti-inflammatory therapy alone.
2. The STOP-HF trial found that screening high-risk patients for heart failure with BNP and providing further assessment and care for those with elevated BNP resulted in less left ventricular dysfunction, heart failure, and emergency hospitalizations compared to usual care.
3. The EchoCRT trial of CRT in patients with narrow QRS found no benefit of CRT and more deaths with CRT, suggesting CRT is not recommended for patients with narrow QRS.
ACE inhibitors were originally synthesized from compounds found in pit viper venom. They work by blocking the conversion of angiotensin I to angiotensin II, lowering blood pressure. Landmark trials showed that ACE inhibitors reduce mortality and hospitalization in heart failure and hypertension. They are now first-line treatment for these conditions as well as post-MI and diabetic kidney disease due to their cardiovascular and renal protective effects. However, trials in low risk patients like PEACE and IMAGINE found no additional benefit of ACE inhibitors beyond standard therapy.
0900 0920 Antiplatelet and Anticoaulation Therapy Aleti FINAL(1).pptxAdelSALLAM4
This document provides guidelines for antiplatelet and anticoagulation therapy. It discusses:
1) Current practice guidelines for managing antiplatelet therapy in CAD patients, including the selection of different antiplatelet medications and optimal durations of dual antiplatelet therapy.
2) Evidence for aspirin, clopidogrel, prasugrel, and ticagrelor in primary and secondary prevention. It finds prasugrel and ticagrelor reduce ischemic events compared to clopidogrel but with potential for higher bleeding risks.
3) Guidelines for dual antiplatelet therapy duration after stent implantation, recommending at least 1 year for most patients but shorter durations for those at high bleeding risk
In patients with PAD, smoking should be stopped and hypertension, dyslipidemia, and diabetes mellitus treated. Patients with PAD should be treated with atorvastatin 40 mg to 80 mg daily or rosuvastatin 20 to 40 mg daily.
ntiplatelet drugs such as aspirin or clopidogrel and angiotensin-converting enzyme inhibitors should be given .Beta blockers should be given if coronary artery disease, especially prior myocardial infarction, s present unless contraindicated. Cilostazol improves exercise time until intermittent claudication. Exercise rehabilitation programs should be used. Indications for lower extremity percutaneous transluminal angioplasty or bypass surgery are 1) incapacitating claudication in patients interfering with work or lifestyle; 2) limb salvage in patientss with limb-threatening ischemia as manifested by rest pain, nonhealing ulcers, and/or infection or gangrene; and 3) vasculogenic impotence.
http://www.scireslit.com/
This document summarizes a randomized controlled trial that compared clopidogrel to ticagrelor or prasugrel in 1002 patients aged 70 years or older with non-ST-elevation acute coronary syndrome. Patients were randomly assigned to receive clopidogrel or ticagrelor/prasugrel. The primary outcome was major or minor bleeding, while the co-primary outcome included mortality, myocardial infarction, stroke, and bleeding. The results found clopidogrel was associated with fewer bleeding events compared to ticagrelor/prasugrel without increasing the risk of the combined clinical outcome. The conclusion is that clopidogrel could be an alternative P2Y12 inhibitor, especially for elderly patients
This document summarizes a presentation given by Prof Kyaw Soe Win on arterial health in hypertension. The presentation covered:
- Cardiovascular diseases are now major causes of mortality, with hypertension as a common risk factor.
- Lifestyle changes like urbanization have led to increased stress and sedentary lifestyles, contributing to rising hypertension rates globally.
- Treating hypertension can significantly reduce cardiovascular outcomes. More intensive control of blood pressure through 24-hour coverage can further reduce risks.
- Choosing antihypertensive drugs that improve arterial health in addition to blood pressure control may maximize cardiovascular protection. Perindopril was highlighted as having properties that protect the endothelium.
1. Platelets play an important role in both normal hemostasis and pathological thromboses like myocardial infarction and stroke. Antiplatelet drugs are commonly used to prevent strokes.
2. Aspirin is recommended for both primary and secondary stroke prevention. Clopidogrel and dipyridamole are also options for secondary prevention. Combination aspirin/dipyridamole may be better than aspirin alone.
3. Newer antiplatelets like ticagrelor inhibit the P2Y12 receptor more effectively than clopidogrel, but trials found no clear benefit over aspirin for acute stroke. Combining aspirin and clopidogrel long-term increases bleeding risk without
This document discusses anti-platelet drugs used to treat arterial thrombi, specifically newer P2Y12 receptor antagonists. It provides details on Clopidogrel, Prasugrel, and Ticagrelor which are widely used due to being more potent than Aspirin. Clinical trials including TRITON-TIMI 38, TRILOGY-ACS and PLATO compared the drugs and found Ticagrelor and Prasugrel superior to Clopidogrel in reducing ischemic events without increasing major bleeding risk. The document concludes the drugs have differences in efficacy against stent thrombosis and risk of bleeding.
The document discusses various antiplatelet drugs including aspirin, P2Y12 receptor antagonists like clopidogrel and prasugrel, and GPllb/llla antagonists. It provides details on the mechanisms and clinical trials of these drugs. Specifically, it summarizes that aspirin works by irreversibly inhibiting platelet COX-1 and reducing thromboxane production. Large trials showed aspirin reduces vascular events by around 25% in high risk patients. Clopidogrel and prasugrel are P2Y12 antagonists but prasugrel has faster onset and greater platelet inhibition. The TRITON trial found prasugrel more effective than clopidogrel for ACS patients
This document discusses antiplatelet therapies used in patients presenting with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PPCI). It summarizes the evidence for aspirin, clopidogrel, prasugrel, and ticagrelor in reducing mortality and cardiovascular events in STEMI patients. Current guidelines recommend a clopidogrel 600mg loading dose or prasugrel or ticagrelor prior to PPCI based on randomized controlled trials demonstrating their efficacy.
Ticagrelor is a reversible P2Y12 platelet inhibitor that was developed as an alternative to clopidogrel for dual antiplatelet therapy following acute coronary syndromes or percutaneous coronary interventions.
The PLATO trial found that ticagrelor was more effective than clopidogrel at reducing the primary endpoint of cardiovascular death, myocardial infarction, and stroke in patients with acute coronary syndrome, with no significant difference in major bleeding risks. However, ticagrelor was associated with higher rates of dyspnea and asymptomatic ventricular pauses.
The PEGASUS trial showed that long-term use of ticagrelor on a background of aspirin reduced the risk of cardiovascular events in patients
Evolving concepts in defining optimal strategies for management of ihdKyaw Win
This document summarizes the key points from guidelines on the management of stable ischemic heart disease. It discusses:
1) The types of angina and progression of coronary atherosclerosis.
2) Goals of drug treatment including reducing cardiac workload and metabolic demand, increasing heart muscle perfusion, and preventing heart attacks.
3) Recommendations for medical management including lifestyle changes, vasculoprotective therapies like aspirin and statins, and first-line antianginal drugs like beta-blockers and calcium channel blockers.
4) The roles of newer antianginal drugs like ivabradine and trimetazidine as second-line options. Revascularization should generally be considered
This document discusses different types of drugs used to modulate clotting, including antiplatelet drugs, fibrinolytics (thrombolytics), and antifibrinolytics. It provides details on specific antiplatelet drugs like aspirin and clopidogrel, fibrinolytic drugs like streptokinase and tissue plasminogen activator, and antifibrinolytics like epsilon amino caproic acid and tranexamic acid. It also outlines their mechanisms of action, dosages, clinical uses, and contraindications in treating conditions like heart attacks, DVTs, and excessive bleeding.
This document discusses antiplatelet treatment strategies in diabetic patients with acute coronary syndrome (ACS). It summarizes several clinical trials comparing different P2Y12 inhibitors in this population. The key points are:
1. Diabetic patients with ACS have higher mortality and morbidity than non-diabetic patients. Clopidogrel response is more variable in diabetics, with higher rates of non-response.
2. A head-to-head trial found ticagrelor reduced platelet reactivity more than prasugrel in diabetic ACS patients after loading doses, with fewer patients having high on-treatment platelet reactivity.
3. Clinical trials showed ticagrelor and prasug
Anti thrombotic therapy in difficult clinical conditionsDrArpan Chouhan
This document discusses anti-thrombotic therapy in difficult clinical conditions. It summarizes various antiplatelet and anticoagulant drugs, difficult situations for their use including high ischemic or bleeding risk, and strategies for balancing thrombotic and hemorrhagic risks. Certain drugs like prasugrel and ticagrelor are preferred for high ischemic burden due to more potent platelet inhibition, while dose adjustments and shorter durations are recommended for high bleeding risk. Careful management is needed in situations like surgery, renal dysfunction, and pregnancy to minimize risks.
This document provides an overview of hemostasis and antithrombotic drugs. It discusses the four phases of hemostasis - vascular, platelet, coagulation, and fibrinolytic. Antithrombotic drugs include antiplatelet drugs that inhibit platelet activation and aggregation, anticoagulants that inhibit fibrin formation, and fibrinolytic agents that degrade fibrin. The document focuses on antiplatelet drugs, describing their mechanisms of action, types including aspirin, clopidogrel, prasugrel, ticagrelor, and glycoprotein IIb/IIIa antagonists. Their uses, pharmacokinetics, adverse effects, and interactions are summarized.
With the growing number of individuals prescribed anti-coagulants, a dilemma exists whether to discontinue the medication few days before the dental innervation or to keep continuing it to prevent the chances of stroke. This presentation covers in detail the pros an cons of discontinuing the anti-platelet medication.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
More Related Content
Similar to Role of antiplatelets in cardiovascular diseases.pptx
- The document discusses secondary prevention of ischemic stroke through the use of antiplatelet agents such as aspirin, ticlopidine, and clopidogrel. These antiplatelet agents provide a modest reduction in risk of non-fatal stroke and death.
- While antiplatelet therapy is effective, more effective and safe treatment options are still needed given the devastating consequences of stroke.
- Acceptable options for initial antiplatelet therapy include aspirin, clopidogrel, ticlopidine, and the combination of aspirin and dipyridamole. Clopidogrel is preferred over ticlopidine due to fewer side effects.
The TWILIGHT trial compared ticagrelor monotherapy to ticagrelor plus aspirin in patients at high risk of bleeding and ischemic events after PCI. Over 7,000 patients received ticagrelor and aspirin for 3 months after PCI. Then patients were randomized to ticagrelor alone or with aspirin for 12 more months. The study found ticagrelor monotherapy was associated with a 44% lower risk of bleeding over 1 year without increasing ischemic events, suggesting it may be a safer option for high risk patients after a brief initial period of dual antiplatelet therapy.
The document discusses various clinical trials related to cardiovascular diseases. It summarizes the ACCORD BP study which found that targeting a SBP of <120 mm Hg compared to <140 mm Hg in patients with type 2 diabetes did not reduce cardiovascular events. It also summarizes the HOPE trial which found that ramipril reduced cardiovascular deaths, myocardial infarction, and stroke in high-risk patients without low ejection fraction or heart failure. Finally, it summarizes the EUROPA trial which found that perindopril reduced the primary endpoint of cardiovascular mortality, non-fatal MI, and cardiac arrest in patients with stable coronary artery disease.
1. A study found that early treatment of a first episode of acute pericarditis with colchicine in addition to standard anti-inflammatory therapy reduced the risk of recurrence compared to anti-inflammatory therapy alone.
2. The STOP-HF trial found that screening high-risk patients for heart failure with BNP and providing further assessment and care for those with elevated BNP resulted in less left ventricular dysfunction, heart failure, and emergency hospitalizations compared to usual care.
3. The EchoCRT trial of CRT in patients with narrow QRS found no benefit of CRT and more deaths with CRT, suggesting CRT is not recommended for patients with narrow QRS.
ACE inhibitors were originally synthesized from compounds found in pit viper venom. They work by blocking the conversion of angiotensin I to angiotensin II, lowering blood pressure. Landmark trials showed that ACE inhibitors reduce mortality and hospitalization in heart failure and hypertension. They are now first-line treatment for these conditions as well as post-MI and diabetic kidney disease due to their cardiovascular and renal protective effects. However, trials in low risk patients like PEACE and IMAGINE found no additional benefit of ACE inhibitors beyond standard therapy.
0900 0920 Antiplatelet and Anticoaulation Therapy Aleti FINAL(1).pptxAdelSALLAM4
This document provides guidelines for antiplatelet and anticoagulation therapy. It discusses:
1) Current practice guidelines for managing antiplatelet therapy in CAD patients, including the selection of different antiplatelet medications and optimal durations of dual antiplatelet therapy.
2) Evidence for aspirin, clopidogrel, prasugrel, and ticagrelor in primary and secondary prevention. It finds prasugrel and ticagrelor reduce ischemic events compared to clopidogrel but with potential for higher bleeding risks.
3) Guidelines for dual antiplatelet therapy duration after stent implantation, recommending at least 1 year for most patients but shorter durations for those at high bleeding risk
In patients with PAD, smoking should be stopped and hypertension, dyslipidemia, and diabetes mellitus treated. Patients with PAD should be treated with atorvastatin 40 mg to 80 mg daily or rosuvastatin 20 to 40 mg daily.
ntiplatelet drugs such as aspirin or clopidogrel and angiotensin-converting enzyme inhibitors should be given .Beta blockers should be given if coronary artery disease, especially prior myocardial infarction, s present unless contraindicated. Cilostazol improves exercise time until intermittent claudication. Exercise rehabilitation programs should be used. Indications for lower extremity percutaneous transluminal angioplasty or bypass surgery are 1) incapacitating claudication in patients interfering with work or lifestyle; 2) limb salvage in patientss with limb-threatening ischemia as manifested by rest pain, nonhealing ulcers, and/or infection or gangrene; and 3) vasculogenic impotence.
http://www.scireslit.com/
This document summarizes a randomized controlled trial that compared clopidogrel to ticagrelor or prasugrel in 1002 patients aged 70 years or older with non-ST-elevation acute coronary syndrome. Patients were randomly assigned to receive clopidogrel or ticagrelor/prasugrel. The primary outcome was major or minor bleeding, while the co-primary outcome included mortality, myocardial infarction, stroke, and bleeding. The results found clopidogrel was associated with fewer bleeding events compared to ticagrelor/prasugrel without increasing the risk of the combined clinical outcome. The conclusion is that clopidogrel could be an alternative P2Y12 inhibitor, especially for elderly patients
This document summarizes a presentation given by Prof Kyaw Soe Win on arterial health in hypertension. The presentation covered:
- Cardiovascular diseases are now major causes of mortality, with hypertension as a common risk factor.
- Lifestyle changes like urbanization have led to increased stress and sedentary lifestyles, contributing to rising hypertension rates globally.
- Treating hypertension can significantly reduce cardiovascular outcomes. More intensive control of blood pressure through 24-hour coverage can further reduce risks.
- Choosing antihypertensive drugs that improve arterial health in addition to blood pressure control may maximize cardiovascular protection. Perindopril was highlighted as having properties that protect the endothelium.
1. Platelets play an important role in both normal hemostasis and pathological thromboses like myocardial infarction and stroke. Antiplatelet drugs are commonly used to prevent strokes.
2. Aspirin is recommended for both primary and secondary stroke prevention. Clopidogrel and dipyridamole are also options for secondary prevention. Combination aspirin/dipyridamole may be better than aspirin alone.
3. Newer antiplatelets like ticagrelor inhibit the P2Y12 receptor more effectively than clopidogrel, but trials found no clear benefit over aspirin for acute stroke. Combining aspirin and clopidogrel long-term increases bleeding risk without
This document discusses anti-platelet drugs used to treat arterial thrombi, specifically newer P2Y12 receptor antagonists. It provides details on Clopidogrel, Prasugrel, and Ticagrelor which are widely used due to being more potent than Aspirin. Clinical trials including TRITON-TIMI 38, TRILOGY-ACS and PLATO compared the drugs and found Ticagrelor and Prasugrel superior to Clopidogrel in reducing ischemic events without increasing major bleeding risk. The document concludes the drugs have differences in efficacy against stent thrombosis and risk of bleeding.
The document discusses various antiplatelet drugs including aspirin, P2Y12 receptor antagonists like clopidogrel and prasugrel, and GPllb/llla antagonists. It provides details on the mechanisms and clinical trials of these drugs. Specifically, it summarizes that aspirin works by irreversibly inhibiting platelet COX-1 and reducing thromboxane production. Large trials showed aspirin reduces vascular events by around 25% in high risk patients. Clopidogrel and prasugrel are P2Y12 antagonists but prasugrel has faster onset and greater platelet inhibition. The TRITON trial found prasugrel more effective than clopidogrel for ACS patients
This document discusses antiplatelet therapies used in patients presenting with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PPCI). It summarizes the evidence for aspirin, clopidogrel, prasugrel, and ticagrelor in reducing mortality and cardiovascular events in STEMI patients. Current guidelines recommend a clopidogrel 600mg loading dose or prasugrel or ticagrelor prior to PPCI based on randomized controlled trials demonstrating their efficacy.
Ticagrelor is a reversible P2Y12 platelet inhibitor that was developed as an alternative to clopidogrel for dual antiplatelet therapy following acute coronary syndromes or percutaneous coronary interventions.
The PLATO trial found that ticagrelor was more effective than clopidogrel at reducing the primary endpoint of cardiovascular death, myocardial infarction, and stroke in patients with acute coronary syndrome, with no significant difference in major bleeding risks. However, ticagrelor was associated with higher rates of dyspnea and asymptomatic ventricular pauses.
The PEGASUS trial showed that long-term use of ticagrelor on a background of aspirin reduced the risk of cardiovascular events in patients
Evolving concepts in defining optimal strategies for management of ihdKyaw Win
This document summarizes the key points from guidelines on the management of stable ischemic heart disease. It discusses:
1) The types of angina and progression of coronary atherosclerosis.
2) Goals of drug treatment including reducing cardiac workload and metabolic demand, increasing heart muscle perfusion, and preventing heart attacks.
3) Recommendations for medical management including lifestyle changes, vasculoprotective therapies like aspirin and statins, and first-line antianginal drugs like beta-blockers and calcium channel blockers.
4) The roles of newer antianginal drugs like ivabradine and trimetazidine as second-line options. Revascularization should generally be considered
This document discusses different types of drugs used to modulate clotting, including antiplatelet drugs, fibrinolytics (thrombolytics), and antifibrinolytics. It provides details on specific antiplatelet drugs like aspirin and clopidogrel, fibrinolytic drugs like streptokinase and tissue plasminogen activator, and antifibrinolytics like epsilon amino caproic acid and tranexamic acid. It also outlines their mechanisms of action, dosages, clinical uses, and contraindications in treating conditions like heart attacks, DVTs, and excessive bleeding.
This document discusses antiplatelet treatment strategies in diabetic patients with acute coronary syndrome (ACS). It summarizes several clinical trials comparing different P2Y12 inhibitors in this population. The key points are:
1. Diabetic patients with ACS have higher mortality and morbidity than non-diabetic patients. Clopidogrel response is more variable in diabetics, with higher rates of non-response.
2. A head-to-head trial found ticagrelor reduced platelet reactivity more than prasugrel in diabetic ACS patients after loading doses, with fewer patients having high on-treatment platelet reactivity.
3. Clinical trials showed ticagrelor and prasug
Anti thrombotic therapy in difficult clinical conditionsDrArpan Chouhan
This document discusses anti-thrombotic therapy in difficult clinical conditions. It summarizes various antiplatelet and anticoagulant drugs, difficult situations for their use including high ischemic or bleeding risk, and strategies for balancing thrombotic and hemorrhagic risks. Certain drugs like prasugrel and ticagrelor are preferred for high ischemic burden due to more potent platelet inhibition, while dose adjustments and shorter durations are recommended for high bleeding risk. Careful management is needed in situations like surgery, renal dysfunction, and pregnancy to minimize risks.
This document provides an overview of hemostasis and antithrombotic drugs. It discusses the four phases of hemostasis - vascular, platelet, coagulation, and fibrinolytic. Antithrombotic drugs include antiplatelet drugs that inhibit platelet activation and aggregation, anticoagulants that inhibit fibrin formation, and fibrinolytic agents that degrade fibrin. The document focuses on antiplatelet drugs, describing their mechanisms of action, types including aspirin, clopidogrel, prasugrel, ticagrelor, and glycoprotein IIb/IIIa antagonists. Their uses, pharmacokinetics, adverse effects, and interactions are summarized.
With the growing number of individuals prescribed anti-coagulants, a dilemma exists whether to discontinue the medication few days before the dental innervation or to keep continuing it to prevent the chances of stroke. This presentation covers in detail the pros an cons of discontinuing the anti-platelet medication.
Similar to Role of antiplatelets in cardiovascular diseases.pptx (20)
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
2. Intended learning objectives
• Definition of antiplatelet drugs, and it’s different classes.
• Mechanism of action of different antiplatelet drugs.
• Role of antiplatelet in different diseases.
• Major trials that studied antiplatelet drugs in coronary diseases.
3. Drugs used in thrombosis
Drug Action
Antiplatelets Prevent and inhibit platelet activation and
aggregation.
Anticoagulants Prevent clotting by inhibiting clotting factors
(coagulation process)
Thrombolytics / Fibrinolytics Dissolve existing thrombi or emboli, and used
in acute treatment of thrombosis
5. What are the antiplatelet drugs?
• The principal function of platelets is to prevent bleeding by thrombus formation.
• Antiplatelet drugs interfere with this function and are useful in prophylaxis of
thromboembolic events.
7. Role of Platelets in Thrombosis
After vascular injury, platelets are bound to exposed collagen and von Willebrand
factor (vWF) and activated.
vWF: von Willebrand Factor; ADP: Adenosine Di-Phosphate; TXA2: Thromboxane A2
8. Role of Platelets in Thrombosis
Activated platelets then secrete thromboxane A2 (TXA2) and adenosine diphosphate
(ADP), which leads to platelet aggregation and recruitment of more platelets.
9. Role of Platelets in Thrombosis
The final common pathway of platelet aggregation is mediated by glycoprotein (GP)
IIb & IIIa receptors that bind to fibrinogen and vWF, leading to platelet plug and clot
formation.
12. Cyclooxygenase Inhibitor: Aspirin Arachidonic acid
pathway inhibitor MOA
Aspirin in low doses irreversibly inhibits
COX-1, which is required for synthesis of
TXA2 a vasoconstrictor required for
platelet aggregation.
At higher doses, ASA also inhibits COX-
2, which is required for prostacyclin
production; prostacyclin are inhibitors
of platelet aggregation and vasodilators.
Optimum dose must be adjusted
13. Aspirin Uses
• Acute coronary syndromes
• Chronic stable angina
• Peripheral arterial disease
• Primary prevention In men aged 45–79 years (for reduction of MIs) and women
aged 55–79 years (for reduction of ischemic strokes), if their potential benefit exceeds the risk
of GI bleed.
16. P2Y12 Receptor Blockers, ADP pathway
inhibitors
Clopidogrel
• Clopidogrel has replaced ticlopidine.
• Longer duration of action ( once daily ).
• Less neutropenia.
• Not affected by food.
• Used to reduce the risk of thrombotic
cardiovascular events
• A prodrug has to be activated in liver,
has a slow onset of action.
Prasugrel and Ticagrelor
• New ADP pathway inhibitors.
• Faster onset of action than clopidogrel.
• Don’t need hepatic activation
• Used to reduce the risk of thrombotic
cardiovascular events
• Both increase bleeding risk.
• Ticagrelor cause dyspnea.
17. Intended learning objectives
• Definition of antiplatelet drugs, and it’s different classes.
• Mechanism of action of different antiplatelet drugs.
• Role of antiplatelet in different diseases.
• Major trials that studied antiplatelet drugs.
18. CAPRIE: Clopidogrel
versus Aspirin in Patients
at risk of Ischemic Events
Purpose
To assess the relative efficacy of the
antiplatelet drugs clopidogrel and aspirin
in reducing the risk of thrombotic events
in patients with atherosclerotic disease.
Design
Multicenter, multinational, randomized,
double-blind, parallel group Patients
19,185 patients with atherosclerotic
vascular disease (either recent ischemic
stroke, recent MI or symptomatic
peripheral arterial disease)
Reference CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348:1329–39.
,P<0.043
RRR = 9%
There were no major differences in terms of safety
19. Results
Reference
CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348:1329–39.
20. Conclusion
Reference
CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348:1329–39.
Long-term administration of clopidogrel to patients
with atherosclerotic vascular disease is more effective
than aspirin in reducing the combined risk of ischemic
stroke, myocardial infarction, or vascular death. The
overall safety profile of clopidogrel is at least as good as
that of medium-dose aspirin.
21. Comparison of different regimens
Endpoint ASA VS Placebo Clopidogrel VS ASA
MACE -19% -9%
Mortality -10% -2% (NS)
22. CHARISMA:
Clopidogrel + ASPIRIN
VS ASPIRIN alone in
high risk patients
Reference
Bhatt DL et al. Am Heart J. 2004;148:263-8. Bhatt DL et al. N Engl J Med. 2006;354:1706-17. Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events
(CAPRIE). Lancet 1996;348:1329–39.
Purpose
Does long-term treatment with clopidogrel
plus aspirin provide greater vascular
protection than aspirin alone in a broad
population of high-risk patients?
Design
Randomly assigned 15,603 patients with
either clinically evident cardiovascular
disease or multiple risk factors to receive
clopidogrel (75 mg per day) plus low-dose
aspirin (75 to 162 mg per day) or placebo
plus low-dose aspirin and followed them
for a median of 28 months.
RRR = 7%,
NS
0.93 (0.83-1.05), P=0.22
23. CHARISMA: Secondary endpoint
UA: Unstable Angina
Reference
Bhatt DL et al. Am Heart J. 2004;148:263-8. Bhatt DL et al. N Engl J Med. 2006;354:1706-17. Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events
(CAPRIE). Lancet 1996;348:1329–39.
24. CHARISMA: Safety endpoints
Clopidogrel +
ASA (% of
patients)
Placebo + ASA
(% of patients)
P-Value
Severe bleeding 1.7 1.3 0.09
Fatal bleeding 0.3 0.2 0.17
Intracranial
hemorrhage
0.3 0.3 0.89
Moderate
bleeding
2.1 1.3 <0.001
GUSTO: Global utilization of streptokinase and t-PA for occluded coronary arteries.
Reference
Bhatt DL et al. Am Heart J. 2004;148:263-8. Bhatt DL et al. N Engl J Med. 2006;354:1706-17. Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events
(CAPRIE). Lancet 1996;348:1329–39.
25. Results Summary
1ry efficacy endpoint Non-significant reduction
Principal 2ry efficacy endpoint Significant reduction
Severe bleeding Non-significant Increase but a trend
noted
Moderate bleeding Significant Increase
26. Comparison of different regimens
Endpoint ASA VS
Placebo
Clopidogrel VS
ASA
ASA +
Clopidogrel VS
ASA
MACE -19% -9% -7% (NS)
Mortality -10% -2% (NS) -1% (NS)
27. Prevention of Cardiovascular Events in
Patients With Prior Heart Attack Using
Ticagrelor Compared to Placebo on a
Background of Aspirin (2015)
RRR
=
15%
RRR
=
16%
30. Reduced the risk
of CV death, MI or
stroke
The benefit of
ticagrelor was
consistent
Increased the risk
of TIMI major
bleeding, but not
fatal bleeding or
ICH
31. Comparison of different regimens
Endpoint ASA Clopidogrel
VS ASA
ASA +
Clopidogrel
VS ASA
ASA +
Ticagrelor
VS ASA
MACE -19% -9% -7% (NS) -16%
Mortality -10% -2% (NS) -1% (NS) -11% (NS)
32. Trial TWILIGHT (2019) THEMIS PCI (2019)
Intervention VS Control (Ticag. + Aspirin) VS Aspirin Ticag. alone VS (Ticag. + Aspirin)
Patients 50 years or older, with type 2
diabetes, with stable coronary
artery disease, a history of
previous PCI.
Previous PCI with high risk for
bleeding or an ischemic event and
completed 3 months of dual
antiplatelet therapy.
Conclusion • Ticagrelor added to aspirin
reduced cardiovascular death,
myocardial infarction, and
stroke, although with increased
major bleeding.
• Ticagrelor provided a favorable
net clinical benefit (more than
in patients without history of
PCI).
• Ticagrelor monotherapy was
associated with a lower
incidence of clinically relevant
bleeding than ticagrelor plus
aspirin.
• No higher risk of death,
myocardial infarction, or
stroke.
35. COURAGE:
Optimal Medical
Therapy with or without
PCI for Stable Coronary
Disease (2007)
Design
Randomized trial involving 2287
patients who had objective evidence of
myocardial ischemia and significant
coronary artery disease. Assigned 1149
patients to undergo PCI with optimal
medical therapy (PCI group) and 1138 to
receive optimal medical therapy alone
(medical-therapy group).
The primary outcome was death from
any cause and nonfatal myocardial
infarction during a follow-up period of
2.5 to 7.0 years
Death from any cause and MI
Incidence of ACS
36. COURAGE:
Optimal Medical
Therapy with or without
PCI for Stable Coronary
Disease
Conclusion.
As an initial management
strategy in patients with stable
coronary artery disease, PCI did
not reduce the risk of death,
myocardial infarction, or other
major cardiovascular events
when added to optimal medical
therapy..
Overall Survival
Incidence of MI
37. Design
OMT: Optimum Medical Treatment
The primary outcome was the rate of death from any cause
The STICH Trial
Coronary-Artery Bypass
Surgery in Patients with Left
Ventricular Dysfunction
(2011)
1212
MT+
CABG
MT 610
602
EF≤ 35% +
CAD
Death from any cause
38. OMT: Optimum Medical Treatment
The STICH Trial
Coronary-Artery Bypass
Surgery in Patients with Left
Ventricular Dysfunction
(2011)
Conclusion
no significant difference between
medical therapy alone and medical
therapy plus CABG with respect to
the primary end point of death from
any cause.
CABG patients had lower rates of
death from cardiovascular causes and
of death from any cause or
hospitalization for cardiovascular
causes.
Death from CV causes
Death from any cause + Hosp. for CV causes
39. The ISCHEMIA Trial
Impact of Completeness of
Revascularization on Clinical
Outcomes in Patients With
Stable Ischemic Heart Disease
Treated With an Invasive Versus
Conservative Strategy (2020)
Design
OMT: Optimum Medical Treatment
Primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or
hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest.
1ry outcome
HR =
0.93 [CI], 0.80 to
1.08; P=0.34)
Death from any
cause
HR =
1.05 [CI], 0.83 to
1.32; P=0.34)
40. The ISCHEMIA Trial
Impact of Completeness of
Revascularization on Clinical
Outcomes in Patients With
Stable Ischemic Heart Disease
Treated With an Invasive Versus
Conservative Strategy (2020)
Conclusion
In patients with coronary disease and
moderate or severe ischemia. We did
not find evidence that the initial
invasive strategy reduced the risk of
ischemic cardiovascular events or
death from any cause.
OMT: Optimum Medical Treatment
Death from CV
causes or MI
HR = NA
MI
HR = NA
42. REVIVED-BCIS2
Revascularization for
Ischemic Ventricular
Dysfunction (2022)
Conclusion
• Multivessel PCI did not improve all-cause
mortality or LV systolic function.
• It remains possible that patients with the
most severe CAD were referred for CABG as
The STICH trial found an association
between CABG and improved survival
among patients with LV systolic dysfunction
and extensive CAD.
• Lack of benefit from PCI may have been due
to less extensive CAD, fewer patients, and
shorter follow-up.
OMT: Optimum Medical Treatment