MD Conference Express AHA 2013 - (Page 45)

The recommendations for oral anticoagulants in ACS from the European Society of Cardiology (ESC) are shown in Figure 1 [Steg PG et al. Eur Heart J 2012], and for duration of triple therapy in AF after stenting are shown in Figure 2 [Verheugt 1 W et al. Circulation 2013]. F 16. Armstrong; Fig Evidence-Based Highlights With Peer-Reviewed Integrity Figure 1. ESC Recommendations for OACs in ACS I IIa IIb III C In patients with clear indication for OAC (eg, AF with CHA2DS2-VASc score ≥2 or mechanical valve), it must be implemented in addition to antiplatelet therapy. C If patients require triple antithrombotic therapy, combining DAPT and OAC, eg, because of stent placement and obligatory indication for OAC, minimize DAPT to reduce bleeding risk. B MD Conference Express fills the gap between live presentation and publication in the academic literature by applying rigorous scientific review to our medical conference highlights reports. In selected patients receiving ASA and clopidogrel, consider low-dose rivaroxaban (2.5 mg BID) if risk of bleeding is low. * Low-dose aspiring (<100 mg/day) * Clopidogrel preferred when combination aspirin and warfarin * Prasugrel and ticagrelor cannot be recommended * Warfarin dose-adjusted INR 2 and 2.5 ASA=aspirin; AF=atrial fibrillation; DAPT=dual antiplatelet therapy; OAC=oral anticoagulant. Reproduced from Steg PG et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;35(20):2569. With permission from Oxford University Press. Figure 2. Recommendations for Duration of Triple Therapy After Stenting in AF 16. Armstrong; Fig 2 VKA+ASA+Clopidogrel Low Bleeding Risk Elective BMS* Elective DES (-olimus) Elective DES (paclitaxel) ACS + BMS/DES High Bleeding Risk** Elective BMS* ACS + BMS VKA+Clopidogrel (or ASA) 1 Month 6 Months 12 Months 1 Month 6 Months VKA 12 Months Low Stent Thrombosis Risk and Low Bleeding Risk BMS DES 1 Month 6 Months 1 Scientific committee guides topic selection 12 Months High Stent Thrombosis Risk and Low Bleeding Risk BMS DES 1 Month 6 Months 4 12 Months Any Stent Thrombosis Risk and High Bleeding Risk BMS Not Recommended DES 1 Month 6 Months ACS=acute coronary syndromes; VKA=vitamin K antagonist. BMS=bare-metal 12 Months stent; DES=drug-eluting OUR 5-STEP PEER-REVIEW PROCESS Independent peer-review ensures accuracy and fair balance stent; Reproduced from Verheugt FW et al. Antithrombotic Therapy During and After Percutaneous Coronary Intervention in Patients With Atrial Fibrillation. Circulation 2013;128:2058-2061. With permission from Lippincott, Williams and Wilkins. Dr. Armstrong sees on the horizon smarter dosing, in vitro physiologic monitoring, personalized medicine, effective antidotes, and a dynamic assessment of risk-benefit. The ongoing PIONEER AF-PCI study [NCT01830543] will help to answer the question of appropriate AT therapy in patients with ACS and AF. 2 A publication of 3 Data-driven content referenced against primary sources 5 Faculty confirm data and/or provide post-conference updates Editors finalize publication +1-617-370-8088 www.goodwingroupintl.com reports@goodwingroupintl.com www.mdconferencexpress.com visit us, like us, and twitt Official Peer-Reviewed Highlights From the American Heart Association Scientific Sessions 2013 45  http://www.goodwingroupintl.com http://www.goodwingroupintl.com http://www.mdconferencexpress.com http://www.mdconferencexpress.com

Table of Contents for the Digital Edition of MD Conference Express AHA 2013

Contents

MD Conference Express AHA 2013

https://www.nxtbook.com/nxtbooks/md_conference_express/AHA2013
https://www.nxtbookmedia.com