Ticagrelor vs other P2Y12 inhibitors
Ticagrelor is a reversible P2Y12 receptor inhibitor whereas clopidogrel and prasugrel are irreversible inhibitors.
Ticagrelor does not require metabolic activation, absorption is rapid and half life is between 7-12 hours; while clopidogrel and prasugrel requires metabolic activation
P2Y12 receptor inhibition by ticagrelor is more rapid and achieves a markedly higher degree of inhibition of adenosine diphosphate (ADP) mediated platelet aggregation. This is possibly a reason for higher degree of bleeding with ticagrelor than clopidogrel.
Lower rates of fatal bleeds with ticagrelor compared to prasugrel is thought to be du...
Source: Cardiophile MD - May 17, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Over-the-counter cold and flu medicines can affect your heart
As the cold and flu season continues this year, it is important to be aware that many of the most commonly used over-the-counter (OTC) remedies for congestion, aches, pains, and low-grade fevers contain medicines that can have harmful effects on the cardiovascular system. Chief among these medications are nonsteroidal anti-inflammatory drugs (NSAIDs) and decongestants.
NSAIDs and your heart
Certain NSAIDs are associated with a small increase in the relative risk for developing a heart attack, stroke, heart failure, atrial fibrillation, increased blood pressure, and blood clots. NSAIDs relieve pain and inflammation by inhib...
Source: Harvard Health Blog - March 20, 2019 Category: Consumer Health News Authors: Mark Benson, MD, PhD Tags: Cold and Flu Drugs and Supplements Health Heart Health Source Type: blogs
Reversal of ticagrelor – phase 1 trial of a new agent
Reversal of ticagrelor – phase 1 trial of a new agent
Platelet transfusion may be ineffective in reversing the effects of the P2Y12 inhibitor ticagrelor [1]. This is because the free drug binds to fresh platelets [2]. Small reversal effect has been noted with platelet transfusion for the effect of clopidogrel [2].
Phase 1 trial of an antibody capable of reversing the antiplatelet effect of ticagrelor has been presented at the American College of Cardiology Annual Conference 2019, New Orleans, LA. PB2452, ticagrelor reversal agent, is a monoclonal antibody fragment that binds ticagrelor with high affinity. It was a p...
Source: Cardiophile MD - March 18, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
What will you do for this patient transferred to you who is now asymptomatic?
A middle-aged woman with history of hypertension presented to another hospital approximately 2 hours after onset of chest pain and shortness of breath.This ECG was recorded on arrival:What do you think?This is technically a STEMI, with 1.5 mm STE in V1 and 1.5-2.0 mm in V2. The current criteria only require 1mm in V1 and 1.5mm in V2 for a female. However, I think many practitioners might not see this as a clear STEMI, and would instead call this " borderline. " The normal QRS complex with STE and large volume underneath the T-waves in V1-V3 confirm Occlusion MI (OMI). There is not technically STD in V6 and I, however the m...
Source: Dr. Smith's ECG Blog - March 5, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
The VERDICT Trial
This study is unable to comment on whether patients with STEMI(-) Occlusion MI have benefit from emergent cath, because that is not the population studied and this subgroup is not commented on.This study is just the most recent in a long long line of similar literature. Context is everything for understanding this study. See below for an excerpt from theOMI Manifesto which summarizes the existing literature and provides details on each study:-------------------------------------------------------------------------------------------------------------- Counter-argument:“Haven’t there been RCTs showing no benefit for earl...
Source: Dr. Smith's ECG Blog - January 4, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
The computer calls this a “normal ECG”. We'll just keep making this point.
This case was contributed byBrooks Walsh, an emergency physician in Connecticut.A middle-aged woman had an acute onset of chest pain and dyspnea. The symptoms improved somewhat after the paramedic gave her nitroglycerin. The pain had almost resolved by the time an ECG was obtained in the ED:Here is the computer diagnosis What do you think?Perhaps you might think these changes are too subtle to immediately call for the cath lab. But do you think the ECG is “normal?” Well, the computer thought so!Note leadsIII and aVF. There is subtle ST segment elevation in those leads. Although it is not high in absolute term...
Source: Dr. Smith's ECG Blog - December 19, 2018 Category: Cardiology Authors: Brooks Walsh Source Type: blogs
Anterior STEMI and multiform PVCs with Narrow Coupling Interval. When to give beta blockers in acute MI?
Conclusion of first report:In patients with anterior Killip class II or less ST-segment –elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI.Conclusion of 2nd report: In patients with anterior Killip class ≤II STEMI undergoing pPCI, early IV metoprolol before reperfusion resulted in higher long-term LVEF, reduced incidence of severe LV systolic dysfunction and ICD indications, and fewer h...
Source: Dr. Smith's ECG Blog - October 19, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
A " normal ECG " on a busy night
Written by Pendell MeyersWe walked in to an overnight shift with approximately 70 patients in the waiting room and a room full of sign-outs at midnight. At 3:55 AM during that kind of a night shift, this ECG (among many others) was brought from triage for review by my team.We knew only that the ECG belonged to a man in his 50s with chest pain and normal vitals. No prior available.Here is the computer interpretation:So we have a triage-computer-normal ECG.Don ' t bother me with this, right?I ' m sure you can imagine the cognitive burden we had during this type of night. On first review from triage, my attending and I waffle...
Source: Dr. Smith's ECG Blog - October 6, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
A completely healthy 30-something woman with acute chest pain -- this post is loaded with info !!!
p.p1 {margin: 0.1px 0.0px 0.1px 0.2px; font: 11.0px Helvetica}A previously healthy young woman presented to the ED with one hour of acute onset right sided chest pain and pressure, very severe, radiating down the right arm. Here is her initial ED ECG (time 0):What do you think?My impression:without any other information, I looked at this ECG and 2 features stood out: 1) the T-wave in lead I is hyperacute. It is far too large for that QRS. 2) The T-wave in V6 is far too large; it is almost as tall as the R-wave, which is distinctly abnormal. 3) there is slight downsloping ST depression in V2 whi...
Source: Dr. Smith's ECG Blog - September 15, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Watch what happens when " pericarditis " and morphine cloud your judgment
Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve SmithCaseA 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain “similar to his prior MI, but worse.” The pain initially started the daypriorto presentation. The pain roused him from sleep but subsided without intervention. Around 19 hours later, he experienced the same pain, which prompted his presentation to the ED. By this time, three hours had passed from the onset of the pain but it was no longer present. Here is his initial ECG:00:04What do you think? - Sinus rhythm at ~70 bpmSTE in...
Source: Dr. Smith's ECG Blog - July 3, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
Palpitations and Chest Tightness: Should You Activate the Cath Lab (or Give Thrombolytics)?
This case was sent by Jessica Carmichael, and Emergency Physician on active duty at Irwin Army Community Hospital in Fort Riley, Kansas. She trained at Brooke Army Medical Center.ECG and CaseI was sent this ECG with some information, but I looked only at the ECG before reading the text:What do you think?My response was this:" I have not read the text of your email yet, but I would say that this is benign normal variant STE. "(There is also atrial fibrillation without a rapid ventricular response.)" Now I will read your text: "Here is the text:" The following ECG was sent to me by a former resident yesterday and...
Source: Dr. Smith's ECG Blog - June 26, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Benefit vs. social responsibility: a profound ethical dilemma in medicine today
Brilinta, at $6.50 per pill, twice a day, reduces cardiovascular events more than generic Plavix, which costs 50 cents per pill, once a day. But only a little: 20% relative or 2% absolute risk reduction. The event risk was 10% with the more expensive drug and 12% with the one that costs 82% less.
Put differently, if 100 patients were treated with Brilinta for a year, at a cost of $4,680 for each patient, ten patients would still have an event. With clopidogrel, 100 patients, each one at a cost of $180, 12 events would occur. That means two fewer events would happen per 100 patients on Brilinta at an extra cost of $450,000...
Source: Kevin, M.D. - Medical Weblog - April 22, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Policy Cardiology Public Health & Source Type: blogs
Critical Issues in PCI : ” Left ” main cries foul . . . calls for “ Right ” thinkers ?
Conquering left main disease is considered as crowning glory for the Interventional cardiologists. For over three decades , CABG has remained the undisputed modality which is being challenged today. Fortunately, the Incidence of true isolated left main disease is low .(If Medina bifurcation subset is excluded)
With growing expertise , advanced hardware and Imaging ( like a 360 degree OCT fly through view ) one can virtually sit inside the left main and complete a PCI .
Still , coronary care is much . . . much . . . more than a technology in transit !
Most importantly, these complex PCIs require rigorous...
Source: Dr.S.Venkatesan MD - February 10, 2018 Category: Cardiology Authors: dr s venkatesan Tags: CABG Indications cardiac surgery Cardiology -Interventional -PCI cardiology -Therapeutics Cardiology -unresolved questions cardiology wisdom cath lab tips and tricks best option for left main disease left main pci or cabg precombat synta Source Type: blogs
DAPT score – Dual Antiplatelet Therapy Score
DAPT score (Dual Antiplatelet Therapy Score) was developed to dichotomize patients after percutaneous coronary intervention [PCI] into those who will benefit from prolonged DAPT (score 2 or more) and those who are more likely to be harmed by DAPT (score less than 2). A recent study evaluated DAPT with aspirin and clopidogrel given for 2 years vs 6 months in 1970 patients undergoing PCI [1]. Primary efficacy outcomes were death, myocardial infarction or cerebrovascular accident. Primary safety outcome was significant bleeding. In this retrospective study they concluded that prolonged DAPT resulted in harm in patients with l...
Source: Cardiophile MD - November 14, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Instinct is Learned
Mr. Reynolds is a vivid 83 year old who lived alone at home. He walks everyday int he morning first thing before he has a small cup of coffee. His kids bought him an ipad and he uses it to browse the Washington Post, the Wall Street Journal, and the Pittsburgh Post Gazette while eating breakfast.
Every morning it’s the same breakfast…toast with honey and a small cup of yogurt. Then he’s ready to start the day, just when the rest of his neighbors are waking up.
Today however, he ate hist toast and his stomach grumbled, louder than usual. He thought to himself that he’d better get to the bathroom qu...
Source: Mr. Hassle's Long Underpants - November 10, 2017 Category: Emergency Medicine Authors: Doc Shazam Tags: Clinical Source Type: blogs
