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Critical Care Compendium update
LITFL’s Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care. Currently there are almost 1,500 entries with more in the works… Some pages are more developed than others, and all the pages are being constantly revised and improved. Links to new references and online resources are added daily, with an emphasis on those that are free and open access (FOAM!). These pages originated from the FCICM exam study notes created by Dr Jeremy Fernando in 2011, and have been updated, modified and added to since. As such will be particularly us...
Source: Life in the Fast Lane - November 17, 2013 Category: Emergency Medicine Doctors Authors: Chris Nickson Tags: Critical Care Compendium Education eLearning Emergency Medicine Featured CCC LITFL collection Source Type: blogs

What The Probe Into The Brilinta Trial May Mean For AstraZeneca
The drumbeat of investigations launched by this or that government agency into a big drugmaker is often shrugged off, at least by investors, who play wait-and-see since the outcome of such probes can amount to nothing. However, the news that the US Department of Justice is investigating a key trial for the Brilinta bloodthinner sold by AstraZeneca prompted a cautious response from one analyst. What are the feds looking at? As we wrote last week, the inquiry is focused on the PLATO trial, which was used to win FDA approval. There were no other details, but the disclosure came six months after a small group of researchers ra...
Source: Pharmalot - November 5, 2013 Category: Pharma Commentators Authors: esilverman Source Type: blogs

Clopidogrel
is a: a) P2Y12 receptor antagonist b) GP IIb/IIIa inhibitor c) Vitamin K antagonist d) None of the above Correct answer: a) P2Y12 receptor antagonist Clopidogrel, ticlopidine and prasugrel are P2Y12 receptor antagonists. GP IIb/IIIa inhibitors include abciximab, eptifibatide and tirofiban. Warfarin and acenocoumarol are vitamin K antagonists.
Source: Cardiophile MD - November 3, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance P2Y12 receptor antagonist Source Type: blogs

Antiplatelet agent with reversible action
Which of the following anti platelet agent has a reversible action? a) Prasugrel b) Clopidogrel c) Ticlopidine d) Ticagrelor Correct answer: d) Ticagrelor While prasugrel, clopidogrel and ticlopidine are thienopyridines, ticagrelor is a nucleoside analogue with overall similarity to adenosine. As the action is reversible, it acts faster and shorter than clopidogrel. Hence it has be to taken twice daily, while clopidogrel needs to be taken only once daily. But the reversible nature helps when the drug has to be withdrawn prior to surgery.
Source: Cardiophile MD - November 2, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance nucleoside analogue ticagrelor Source Type: blogs

Prolonged Dual Antiplatelet Therapy May Not Be Necessary For Second-Generation Drug-Eluting Stents
The precise duration of dual antiplatelet therapy (DAPT) following implantation of a drug-eluting stent (DES) has been the subject of considerable controversy. On the one hand, prolonged therapy may help prevent late stent thrombosis, which was particularly evident in first generation DESs. On the other hand, the risk of stent thrombosis may have diminished in newer generation drug-eluting stents, and prolonged DAPT  is associated with a greater risk for bleeding complications and additional expense and management issues. In the Optimized Duration of Clopidogrel Therapy Following Treatment With the Zotarolimus-Eluting Ste...
Source: CardioBrief - October 31, 2013 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery antiplatelet therapy DES Drug-eluting stent dual antiplatelet therapy JAMA Medtronic Source Type: blogs

Not So Brilliant? Feds Probe AstraZeneca Over Brilinta Trial Data
Six months after a medical journal raised troubling questions about the reliability of a key study that was used to win approval for its Brilinta bloodthinner, AstraZeneca (AZN) says that the US Department of Justice has recently opened an inquiry into the trial, according to a filing with the US Securities and Exchange Commission. The disclosure was made in the most recent earnings report that was released today (see page 28). An analysis last April in The International Journal of Cardiology found a host of disturbing issues with the so-called Plato trial. Nearly three years ago, the FDA questioned aspects of the study an...
Source: Pharmalot - October 31, 2013 Category: Pharma Commentators Authors: esilverman Source Type: blogs

Drug eluting stent
Drug used for coating coronary stents to reduce restenosis: a) Atorvastatin b) Aspirin c) Sirolimus d) Clopidogrel Correct answer: c) Sirolimus Sirolimus is an antimalignant drug which is used in drug eluting stents which reduces neo-intimal proliferation, the important cause of in stent restenosis after coronary angioplasty with stenting. All the other drugs are helpful in reducing the chance of progression of coronary artery disease and are invariably given after coronary stenting, but are not used for coating drug eluting stents.
Source: Cardiophile MD - September 5, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

What's hot at ESC 2013; German CoreValve use on hold; ESC hot line ACCOAST was halted; Public Citizen to FDA: No more clopidogrel one year post-DES
Source: Blogs@theHeart.org - August 30, 2013 Category: Cardiology Authors: theheart.org Tags: This week in cardiology from heartwire Source Type: blogs

Statins protective against Parkinson's: More evidence; abandoning off-pump CABG surgery?; prasugrel 5 mg, clopidogrel similarly safe, effective; perioperative beta-blocker controversy
Source: Blogs@theHeart.org - August 2, 2013 Category: Cardiology Authors: theheart.org Tags: This week in cardiology from heartwire Source Type: blogs

Man in his 60's with very subtle ECG and pain not controlled with medical therapy
A male in his 60's presented 30 minutes after the onset of crushing substernal chest pain.  Medics recorded 2 ECGs, one before and one after sublingual NTG, and both are similar to the first ED ECG.  The patient had never had pain like this before.  The pain improved from 9/10 to 3/10 after NTG.  Here is the initial ED ECG:QRS axis = 11, T-wave axis = 13.  There are very subtle signs of ischemia here: minimal ST elevation in I and aVL with minimal reciprocal ST depression in lead III.  Most specific is the abnormal ST segment and T-wave in aVF: it is downsloping with a subtly biphasic (down-up...
Source: Dr. Smith's ECG Blog - August 1, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs

Learning crucial cardiology lessons from the patietns !
One of my otherwise  well behaving  patient ,  suddenly asked me this question ,  before leaving my  clinic  after a 15 minute consult . Doctor  . . . I am taking the clopidgrel and aspirin  for 5 years like a vitamin tablet  . . . is that all right  doctor I just got curious, I checked  the prescription again . Yeh ,  he was right ! I have  been mechanically writing  Tablet Clopitab  A  since 2008 ! For what ? Some sort of CAD !  Was it for a ACS . No . . . it was for chronic stable angina  No PCI,  . . . no DES ? Why the hell  he is taking dual anti-platelet  therapy for 5 years ? Some  body  , s...
Source: Dr.S.Venkatesan MD - July 31, 2013 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics cardiology-ethics Clinical cardiology general medicine cardiologist cartoon cardiology cartoons cardiology consultations cardiology medical consultations cartoon medical clopidogrel doctor patient relationship humour based Source Type: blogs