Unstable Angina and NSTEMIs: Management Principles Meira Louis Lisa Campfens.

Slides:



Advertisements
Similar presentations
Should we use bivalirudin ? Fibrin 2 1 Thrombin 2 1 Thrombin 2 1 Trombina 2 1 Trombina Bivalirudin ADVANTAGES - No requirement for anti-thrombin III -
Advertisements

Unstable angina and NSTEMI
NSTEMI Acute Coronary Syndromes
“ If physicians would read two articles per day out of the six million medical articles published annually, in one year, they would fall 82 centuries behind.
Khawar Kazmi. Thrombosis LipidsInflammation Thrombus Platelets and thrombin Quiescent Plaque Plaque rupture PATHOGENESIS ACUTE CORONARY SYNDROME.
Gregg W. Stone MD for the ACUITY Investigators Gregg W. Stone MD for the ACUITY Investigators A Prospective, Randomized Trial of Bivalirudin in Acute Coronary.
Principles of anticoagulant tratment
1 Update on antiplatelet and anticoagulant drugs: sticky stuff KFJ Ng May 2011.
 Decide on the correct management of patients with acute coronary syndrome based on the findings of a clinical history, examination and relevant test.
Alyssa Morris, R4 September 30,  Mx of UA/NSTEMI in the ED  CRUSADE, COMMIT, ISIS-2, CAPRIE, CURE, PCI- CURE, OASIS-5, OASIS- 7, SYNERGY  NOT.
Initial Therapy Anti-ischemic and Analgesic therapy
OASIS in ACS: with Updates on 2011 ESC Guidelines on Anticoagulation Donato Maranon, MD, FPCP, FPCC, FACC.
Clopidogrel 75 mg per day orally should be added to aspirin in patients with STEMI regardless of whether they undergo reperfusion.
Applications of bivalirudin in interventional cardiology
Evolution of pharmaceutical antithrombotic therapy in CVD Dr Rob Butler Dept of Cardiology University Hospital of North Staffordshire Drug It!
16th Interventional Cardiology Symposium Montreal, Quebec / June 14-16, 2007 Adapted from a presentation by: Shamir R. Mehta, MD, MSc, FRCPC, FACC “Transitioning.
Compared to Heparin/Enoxaparin with GP IIb/IIa inhibitors,Bivalirudin monotherapy significantly reduces major bleeding while providing similar ischemic.
“Challenging practice in non-ST segment elevation Acute Coronary Syndromes (ACS)” Professor Jennifer Adgey Royal Victoria Hospital, Belfast 26th January.
Glycoprotein IIb/IIIa inhibitors and bivalirudin: under utilised? Azfar Zaman Freeman Hospital Newcastle-upon-Tyne.
STEMI < 6 h Lytic eligible Lytic choice by MD (TNK, tPA, rPA, SK) ENOX < 75 y: 30 mg IV bolus SC 1.0 mg / kg q 12 h (Hosp DC) ≥ 75 y: No bolus SC 0.75.
Baseline Characteristics Current or Former Smoker Diabetic Hypertension 25.7 Prior MI Prior Heart Failure.
6/04 CRUSADE: A National Quality Improvement Initiative C an R apid Risk Stratification of U nstable Angina Patients S uppress AD verse Outcomes with E.
Antiplatelets, Anticoagulants What are the consequences Dr Jeremy Wright Cardiologist Hearts1st, Greenslopes Private Hospital.
Safety and Efficacy of Switching from Either UFH or Enoxaparin Plus a GP IIb/IIIa Inhibitor to Bivalirudin Monotherapy in Patients with Non-ST Elevation.
Acute Coronary Syndromes. Learning outcomes To understand the clinical spectrum of coronary disease To recognise different presentations of the disease.
Is Bivalirudin Monotherapy Sufficient for Diabetic Patients with Acute Coronary Syndrome Undergoing PCI? Frederick Feit, Steven Manoukian, Ramin Ebrahimi,
Anticoagulation ACCP guidelines 2012
Pocket Guide to Anticoagulation in AF & Dual Antiplatelet Therapy in ACS Rumi Jaumdally 2015 This brief presentation will summarise the recently published.
Anticoagulation Reversal May 11, Objectives Develop an approach for treating patients with iatrogenic coagulopathy Understand recent changes in.
Dr Jonathan Day Senior Director Global Medical The Medicines Company Bivalirudin Advancing Anticoagulation in ACS.
Intra-procedural Anticoagulation for PCI: Which Drug? How Much? How Long? Michael J. Cowley, FSCAI Nothing to Disclose.
Jong-Yoon Yi, MD, FACC President, Heartland Education & Research Foundation.
Duration Safety and Efficacy of Bivalirudin in patients undergoing PCI: The impact of duration of infusion in ACUITY trial Dr. David Cox Lehigh Valley.
Northeast Georgia Heart Center Interventional Pharmacology: Anti-thrombin Therapy J. Jeffrey Marshall, MD, FSCAI Past President SCAI, Director.
Bivalirudin Monotherapy Improves 30-day Clinical Outcomes in Diabetics with Acute Coronary Syndrome: Report from the ACUITY Trial Frederick Feit, Steven.
TREATMENT OF ACUTE PULMONARY THROMBOEMB0LISM SEYED REZA SEYEDI.MD.
Adjunctive Antithrombotic for PCI Theodore A Bass, MD FSCAI President SCAI Professor of Medicine, University of Florida Medical Director UF Shands CV Center,Jacksonville.
Therapeutics Tutoring
The management of anti-thrombotics in patients undergoing GI endoscopy
Pharmacotherapy Update for STEMI: What Is New?
Heparin Should be the First-line Therapy for Patients with ACS/AMI
Acute Myocardial Infarction
Robert A. Harrington, MD Professor of Medicine
Anesthes. 2013;118(6): doi: /ALN.0b013e318289bcba Figure Legend:
Guidelines for the Management of Patients With ST- Elevation Myocardial Infarction Adapted from Focused Updates: ACC/AHA 2009.
T1: ACS Treatment Tutoring
T1: Post ACS Treatment Tutoring
Initial pharmacotherapy for ST-segment elevation myocardial infarction
Initial pharmacotherapy for ST-segment elevation myocardial infarction
Antiplatelet Therapy For STEMI: The Case for Cangrelor
JM ten Berg, St Antonius Hospital
Anticoagulation in Atrial Fibrillation
Ischaemic Heart Disease Acute Coronary Syndrome
Oral Anticoagulation and Preventing Stent Thrombosis
R. Jay Widmer, MD, PhD, Peter M. Pollak, MD, Malcolm R
Unstable Angina and Non–ST Elevation Myocardial Infarction
The following slides highlight a Hotline presentation at the European Society of Cardiology Congress in Barcelona, Spain, August 29 – September 2, 2009.
Tailoring Antiplatelet Therapy in PCI
“Reversing Direct Oral Anticoagulants”
Section F: Clinical guidelines
Paul A. Gurbel, and Udaya S. Tantry JCHF 2014;2:1-14
Welcome Ask The Experts March 24-27, 2007 New Orleans, LA.
Periprocedural Management of Patients on Anticoagulation
Nat. Rev. Cardiol. doi: /nrcardio
OASIS-5: Study Design Randomize N=20,078 Enoxaparin (N=10,021)
BRIGHT Trial design: Patients undergoing PCI for ACS were randomized in a 1:1:1 fashion to receive either bivalirudin alone, unfractionated heparin (UFH)
Is Bivalirudin Monotherapy Sufficient for Diabetic Patients
New oral anticoagulants and regional anaesthesia
R. Jay Widmer, MD, PhD, Peter M. Pollak, MD, Malcolm R
Bleeding and Outcomes OASIS Registry, OASIS - 2, CURE (n=34,146) Death
Presentation transcript:

Unstable Angina and NSTEMIs: Management Principles Meira Louis Lisa Campfens

Outline Pick your/cardio’s strategy Initial therapy...for everyone? Pick an anti-platelet...or two...or three... Protect the stomach??? PPI controversy Pick the right anti-coagulant Send home the lucky stable one

Evidence? Says Who?

First, conservative or invasive?

ASA

Nitrates

Morphine

Beta Blockers: the good

Beta Blockers: the bad

CCB

CCB dosing

Ace i

Ace i: Is more better?

Lets talk anti- platelets...

Plavix

Plavix: How much?

Prasugrel?

Ticagrelor?

Plato Controversy

Plavix vs GP IIb/IIIa inhibitor

What about adding a PPI?

Anti-Coagulants Indirect inhibitors of coagulation (need antithrombin for their full action) – Indirect thrombin inhibitors: UFH; LMWHs – Indirect factor Xa inhibitors: LMWHs; fondaparinux Direct inhibitors of coagulation – Direct factor Xa inhibitors: apixaban, rivaroxaban, otamixaban – Direct thrombin inhibitors (DTIs): bivalirudin, dabigatran

Bleeding risks

UFH

LMWH

Bivalirudin

Fondaparaneux

Discharge

Take Home Points Initial therapy for everyone – think ASA and nitrates – Be careful with BB, CCB, morphine – Consider ace inhibitors Pick an anti-platelet...or two...or three... – Plavix in everyone at 300mg – Talk to cardio about prasugrel or ticagrelor – Leave the GPI until they go to PCI Protect the stomach! – PPIs show more benefit than harm Pick an anti-coagulant – UFH if high risk or going to CABG – Enox or Bivalirudin if going to PCI – Fonda if conservative strategy or high risk for bleeding For the ones sent home... – ASA and Plavix for at least 1 month – Stress test within 72 hours