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Total 103 results found since Jan 2013.

Period of withdrawal of anti platelet agents prior to surgery
All patients with coronary stents will be on Aspirin and an additional agent which is a P2Y12 inhibitor (Clopidogrel, Prasugrel or Ticagrelor). The antiplatelet therapy is likely to be more aggressive in those on drug eluting stents (DES). More so in those who have been implanted with a DES in the past one year, because the risk of stent thrombosis on withdrawal on antiplatelet agents is higher in that period. Platelet function recovery takes place at the rate of about 10% per day. But full recovery of function may not be required for adequate hemostasis with platelet aggregation. There is also a chance of rebound prothr...
Source: Cardiophile MD - August 8, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Clopidogrel P2Y12 inhibitor Prasugrel rebound prothrombotic state Thromboxane A2 ticagrelor trans urethral resection of prostate TURP and anti platelet therapy withdrawal of anti-platelet agents prior to surgery Source Type: blogs

The difference between Left Main occlusion and Left Main insufficiency
There are many publications stating that ST elevation in lead aVR, with diffuse ST depression elsewhere, is due to "left main occlusion."  This is even stated in the lastest 2013 ACC/AHA STEMI guidelines, and they reference an article by Jong et al. (Int Ht J 2006; 47(1):13-20.) as evidence.  If you go read that article, "occlusion" was defined as any stenosis greater than 50%.  That is not occlusion, which is 100%.  There are many other articles that confuse Left Main occlusion with Left Main insufficiency, and these are the sources of the mistaken belief that this ECG pattern reflects LM occlusio...
Source: Dr. Smith's ECG Blog - August 2, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Research and Reviews in the Fastlane 041
This study prospectively validated whether an age-adjusted D-dimer cutoff was associated with an increased diagnostic yield of D-dimer in elderly patients with suspected PE. Compared with a fixed D-dimer cutoff, the combination of pretest clinical probability assessment with age-adjusted D-dimer cutoff was associated with a larger number of patients in whom PE could be considered ruled out with a low likelihood of subsequent clinical venous thromboembolism. So if this is not your clinical practice already, maybe time to use age adjust d-dimer values? Recommended by: Jerremy Fried Read More: Age Adjusted D-Dimer Testing (RE...
Source: Life in the Fast Lane - July 29, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research R&R in the FASTLANE critical care Emergency Medicine Intensive Care literature recommendations research and reviews Source Type: blogs

Prescription Delay Following Stent Implantation Is a Common and Deadly Problem
After receiving a stent, many patients delay or fail to fill their prescription for clopidogrel or another antiplatelet agent. Now, a study published in the Journal of the American Heart Association offers evidence that this problem is widespread and often leads to serious consequences. Researchers analyzed data from all stent implantations performed in British Columbia from 2004 through 2006. In all, 15,629 stents were implanted: 3,599 patients received at least one drug-eluting stent (DES), and 12,030 received bare metal stents (BMS) alone. Nearly a third of the patients in each stent group did not fill their prescr...
Source: CardioBrief - May 28, 2014 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery Policy & Ethics clopidogrel compliance prescriptions stents Source Type: blogs

True Positive ST elevation in aVL vs. False Positive ST elevation in aVL
Case 1.  A woman in her 60s with no prior history of CAD presented with 3 hours of sharp, centrally located chest pain with radiation to the anterior neck, with associated nausea. She had known HTN and DM.  She appeared to be in distress.  She was given sublingual NTG with improvement, but there was not complete resolution.Here was here initial ECG:There is ST elevation in I and aVL, with inferior reciprocal ST depression in all of II, III, and aVF, and a down-up T-wave in aVF (a sign that is very specific for ischemia).  There is also ST depression in V3-V6.  This ECG is diagnostic of ischemia.It ...
Source: Dr. Smith's ECG Blog - May 12, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

A Stressing Situation
A 64-year-old woman presented to the emergency department with two days of severe nausea, numerous episodes of vomiting, and progressively worsening right upper quadrant/epigastric abdominal pain. She was continuously spitting clear secretions into an emesis bag on arrival in triage. Her 8/10 dull ”ripping” pain originated in the right upper quadrant and radiated in a band-like pattern to her epigastrium. She was not experiencing any chest pain or shortness of breath. Her medical history included hypertension, type 2 diabetes mellitus, recurrent acute pancreatitis secondary to hyperglycemia, peripheral artery disease, ...
Source: Spontaneous Circulation - March 10, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Reversible anti-platelet action
While the anti-platelet actions of clopidogrel and prasugrel are irreversible, that of the following drugs are reversible: •Dipyridamole •Cilostazol •NSAIDS (non steroidal anti-inflammatory drugs) •Ticagrelor
Source: Cardiophile MD - February 22, 2014 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Period of withdrawal of anti-platelet agents prior to surgery
All stented patients will be on Aspirin and an additional agent which is a P2Y12 inhibitor (Clopidogrel, Prasugrel or Ticagrelor). Clopidogrel is withdrawn 5 days prior to surgery while Prasugrel needs to be withdrawn 7 days prior to surgery.
Source: Cardiophile MD - February 22, 2014 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

FDA Advisory Panel Recommends Against Approval Of Cangrelor
The FDA’s Cardiovascular and Renal Drugs Advisory Committee today recommended against the approval of cangrelor, the investigational new antiplatelet drug from the Medicines Company. In a 7-2 vote the panel first rejected an indication  for the reduction of thrombotic cardiovascular events including stent thrombosis in patients undergoing PCI. The panel also voted unanimously to reject a second indication… … Click here to read the full post on Forbes.    
Source: CardioBrief - February 12, 2014 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery People, Places & Events Policy & Ethics antiplatelet Cangrelor clopidogrel FDA PCI Source Type: blogs

Shortest acting P2Y12 receptor inhibitor
: a) Prasugrel b) Clopidogrel c) Cangrelor d) Ticagrelor Correct answer: c) Cangrelor All these drugs act on P2Y12 receptor. The first two are irreversible inhibitors while the later are reversible inhibitors. Cangrelor is short acting so that it has to be given as an infusion. Read more…
Source: Cardiophile MD - January 9, 2014 Category: Cardiology Authors: Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Reversible and irreversible platelet inhibition by anti platelet agents
Agents which irreversibly inhibit platelets are: Aspirin Ticlopidine Clopidogrel Prasugrel In general all these agents except prasugrel are ideally discontinued 5 days prior to intended surgery. Prasugrel is better discontinued 7 days prior, because of slightly different pharmacodynamics profile. Agents which reversibly inhibit platelets are: Dipyridamole Cilostazol Nonsteroidal anti-inflammatory drugs Ticagrelor
Source: Cardiophile MD - January 9, 2014 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Tough calls in cardiology :Dengue fever in a patient with prosthetic valve and warfarin !
Oral anticoagulant usage has been steadily increasing for variety of  indications.Dengue fever is also  appearing in different avatars with  low platelet counts  and bleeding being a primary risk. I was recently contacted by a physician , regarding a therapeutic dilemma .A young lady with mitral prosthetic valve and a febrile illness diagnosed as dengue . She has a platelet  count of 100,000 .She is on regular warfarin and aspirin .The physician  wanted to know , should he stop the OAC and aspirin ? What are the options ? Confirm if it is really dengue. Look for clinical bleeding.INR, platelet function tests are not...
Source: Dr.S.Venkatesan MD - December 5, 2013 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -guidelines Cardiology -Mechnisms of disease Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions Cardiology-Statistics dengue and coronary stent des and dengue falling platlets and coroanry Source Type: blogs

FDA Spanks 23andMe, Grants Breakthrough Status To Factor Xa Inhibitor, and Approves Promus Premier Stent
It was a busy morning at the FDA. Three new FDA actions may be of considerable interest in the cardiology universe: FDA Halts 23andMe Personal Genome Test– The FDA sent a scathing letter to 23andMe ordering the company to stop selling its Personal Genome Service (PGS) test.   The FDA highlighted two cardiology-related uses of PGS as “particularly concerning,” including drug responses involving warfarin sensitivity and clopidogrel response. … FDA Grants Breakthrough Status To Factor Xa Inhibitor Antidote–  … FDA Approves Promus Premier Everolimus-Eluting Platinum Chromium Coronary S...
Source: CardioBrief - November 25, 2013 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery People, Places & Events Policy & Ethics 23andMe anticoagulants DNA FDA food and drug administration PGS stents Source Type: blogs