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CARDIOVASCULAR DISEASE > ANTIPLATELET GUIDELINES > Flashcards

ANTIPLATELET GUIDELINES Flashcards

1
Q

High Risk of Thrombotic Events

A

Prior MI or trop positive ACS
DM on oral meds or insulin
CKD (CrCl < 60)
Previous stent thrombosis
Current smoker

> /3 stents
Long lesion > 60 mm total stent
Complex lesion (bifurcation with 2 stents, chronic occlusion)
Lt main or proximal LAD
Multivessel PCI

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2
Q

Risk Factors for Bleeding

A

OAC + DAPT
> 75
Frailty
Hgb < 110
CRF (CrCl < 40)
BW < 60 kg
Hospitalization for bleed < 1 yr
Previous stroke / ICB
Regular need for NSAID or Prednisone

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3
Q

Duration of DAPT in Patients with ACS (STEMI or NSTEMI) who Undergo PCI

A

DAPT for 1 year

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4
Q

Preferred DAPT in Patients with ACS (STEMI or NSTEMI) who Undergo PCI

A

ASA 81 mg once daily +Ticagrelor 90 mg BID or Prasugrel 10 mg once daily
preferred over Clopidogrel 75 mg once daily

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5
Q

What do you reassess at 1 year in Patients with ACS (STEMI or NSTEMI) who Undergo PCI on DAPT

A

At 1 year, determine bleeding risk

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6
Q

Recommendations at 1 year for patients with ACS (STEMI or NSTEMI) who Undergo PCI on DAPT with low bleeding risk

A

Continue DAPT for up to 3 years
ASA 81 mg once daily +Ticagrelor 60 mg BID or
Clopidogrel 75 mg once daily2

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7
Q

Recommendations at 1 year for patients with ACS (STEMI or NSTEMI) who Undergo PCI on DAPT with high bleeding risk

A

SAPT
ASA 81 mg once daily or
Clopidogrel 75 mg once daily

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8
Q

Duration of DAPT in Patients who Undergo Elective PCI Not at high risk of bleeding

A

DAPT for 6 months
ASA + clopidogrel

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9
Q

Duration of DAPT in Patients who Undergo Elective PCI at high risk of bleeding

A

DAPT for 1 month if BMS,
or 3 months if DES
THEN
SAPT
ASA 81 mg daily or
Clopidogrel 75 mg daily

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10
Q

Duration of DAPT in Patients who Undergo Elective PCI with High-risk clinical or angiographic features for thrombotic cardiovascular events,
and not at high risk of bleeding

A

Extend DAPT up to 3 years
ASA 81 mg daily + Clopidogrel 75 mg daily

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11
Q

Interrupting DAPT for Non-Cardiac Surgery: BMS

A

recommend delaying surgery for at least 1 month after PC
Continue ASA perioperatively
withhold clopidogrel and ticagrelor for 5-7 days pre-operatively
withold prasugrel for 7-10 days pre-operatively

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12
Q

Interrupting DAPT for Non-Cardiac Surgery: DES

A

recommend delaying surgery
for at least 3 months after PCI
Continue ASA perioperatively
withhold clopidogrel and ticagrelor for 5-7 days pre-operatively
withold prasugrel for 7-10 days pre-operatively

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13
Q

When to restart DAPT in PCI after non cardiac surgery

A

restart maintenance dose after surgery, as soon as it is deemed safe by the surgeon

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14
Q

Management of DAPT for Elective or Semi-urgent CABG Surgery after ACS (minimum vs. ideal)

A

continuation of ASA
minimum interruption of ticagrelor and clopidogrel for 48-72 hours before CABG ideal interruption period of 5 days before elective CABG
minimum interruption of prasugrel for 5 days before CABG and recommend an ideal interruption period of 7 days before elective CABG

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15
Q

Switching from clopidogrel to ticagrelor

A

Loading dose: 180 mg
Maintenance dose: 90 mg twice daily
Timing: regardless of the timing of the last clopidogrel dose

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16
Q

Switching from clopidogrel to prasugrel

A

Loading dose: 60 mg
Maintenance dose: 10 mg daily
Timing: regardless of the timing of the last clopidogrel dose

17
Q

Switching from prasugrel to ticagrelor

A

Loading dose: None
Maintenance dose: 90 mg twice daily
Timing: At next scheduled dose

18
Q

Switching from ticagrelor to prasugrel

A

Loading dose: 60 mg
Maintenance dose: 10 mg daily
Timing: At next scheduled ticagrelor dose

19
Q

Switching from ticagrelor to clopidogrel

A

Loading dose: Optional loading 300-600 mg *
Maintenance dose: 75 mg daily
Timing: At next scheduled ticagrelor dose†

20
Q

Switching from prasurgel to clopidogrel

A

Loading dose: None
Maintenance dose: 75 mg daily
Timing: At next scheduled dose

21
Q

Patients with AF without High-Risk Features who Undergo Elective PCI: Age < 65 and CHADS2 = 0

A

ASA + Clopidogrel
Duration: at least 1 month for BMS and at
least 3 months for DES (and up to 12 months)

22
Q

Patients with AF without High-Risk Features who Undergo Elective PCI: Age ≥ 65 or CHADS2 ≥ 1

A

OAC2 + Clopidogrel
Duration: at least 1 month for BMS and at
least 3 months for DES (and up to 12 months)

23
Q

Patients with AF who Undergo PCI for ACS or High-Risk Elective PCI: Age < 65 and CHADS2 = 0

A

ASA + P2Y12 inhibitor2
(ticagrelor, prasugrel preferred
over clopidogrel for ACS)
Duration after PCI: Up to 12 months

24
Q

Patients with AF who Undergo PCI for ACS or High-Risk Elective PCI: Age ≥ 65 or CHADS2 ≥ 1

A

Reduced OAC3 + ASA + clopidogrel
ASA: stop 1 day post PCI or any time up to 6 months4
Followed by: clopidogrel + OAC
Duration after PCI: Up to 12 months

25
Q

Patients with Venous Thromboembolism OR established left ventricular thrombus Undergoing PCI for an ACS or non-ACS indication

A

initial regimen of ASA 81 mg daily plus clopidogrel 75 mg daily plus either parenteral OR oral anticoagulation (in accordance with
DVT/PE recommendations).

ASA may be discontinued as early as the day following PCI or it can be continued up to 6 months of treatment, depending on the risk of recurrent ischemic events versus major bleeding.

Following ASA discontinuation, we suggest that OAC plus clopidogrel
75 mg daily be continued for up to 12 months after the initial PCI

26
Q

In patients undergoing PCI for an ACS indication who are high-risk of developing LV thrombus

A

DAPT with ASA 81 mg daily plus either ticagrelor 90 mg twice daily or prasugrel 10 mg once daily
for up to 1 year

27
Q

In patients with a mechanical valve replacement who undergo PCI for an ACS or non-ACS indication:

A

ASA 81 mg daily plus clopidogrel 75 mg daily plus a vitamin
K antagonist (VKA) (triple therapy).

ASA may be discontinued as early as the day after PCI or it can be continued up to 6 months of treatment,

28
Q

In patients with a surgical bioprosthetic valve replacement (implanted < 6 months) who undergo PCI for an ACS or non-ACS indication:

A

DAPT with ASA 81 mg daily and clopidogrel
75 mg daily for at least 6 months (and up to 12 months)

29
Q

In patients with a transcatheter aortic valve replacement (TAVR) (implanted < 6 months) who undergo PCI for an ACS or non-ACS indication:

A

DAPT with ASA 81 mg daily and
clopidogrel 75 mg daily for 3-6 months

CARDIOVASCULAR DISEASE (20 decks)

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