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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)
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 Clopidogrel is withdrawn 5 days prior to surgery while Prasugrel needs to be withdrawn 7 days prior to surgery.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)
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)
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

P2Y12 Inhbitors in the ED for NonSTEMI. Criticisms of the ACCOAST-ed trial of Upstream vs. Delayed Prasugrel
Rick Body had a nice piece in St. Emlyn's about the ACCOAST-ed trial, a study recently published in the NEJM on the use of Prasugrel in NonSTEMI: should it be given "upstream" in the ED, or should it be delayed until the anatomy is defined by angiography? The study found no difference between upstream and waiting.Here is Rick's piece.I have these criticisms of the trial, and am still using Clopidogrel 600 mg for NonSTEMI:Patients planned for intervention within 2-48 hours, but they do not break down the data on whether their was efficacy for those whose intervention was closer to 48 hours. Sitting on these pati...
Source: Dr. Smith's ECG Blog - January 22, 2014 Category: Cardiology Authors: Steve Smith 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)
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)
Source: Cardiophile MD - January 9, 2014 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Ischemic Chest Pain and Hypertension: Use of Adjunctive Anti-ischemic Therapy
A middle aged male with several CAD risks has had several months of exertional angina relieved by rest and nitro. He had the onset of chest discomfort at rest and presented by ambulance about 3 hours later with "severe crushing chest pain," with a blood pressure of 200/100 and pulse of 100. The prehospital ECG cannot be found. Here is his initial ED ECG:Sinus rhythm, nearly tachycardia. Left axis deviation with QRS of 90 ms, R-wave peak time in aVL perhaps reaches 45 ms, so possible left anterior fascicular block. There is minimal ST depression (but also a wandering baseline) in V3-V6.Exam was...
Source: Dr. Smith's ECG Blog - January 7, 2014 Category: Cardiology Authors: Steve Smith 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

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)
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)
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