Stroke
DAPT after an ischemic stroke or TIA?
New data will raise questions about optimal use of short-term dual antiplatelet therapy (DAPT) after an ischemic stroke or TIA. We know that short-term DAPT, such as aspirin plus clopidogrel for 21 days, reduces recurrent stroke risk compared to aspirin alone. But most evidence is with starting DAPT within 24 hours. And data are mostly for patients with a minor st…
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Dual Antiplatelet Therapy
DAPT duration for patients at HIGH bleeding risk
As a cardiovascular pharmacist, you will hear debate about shorter dual antiplatelet therapy (DAPT) durations after a stent in acute coronary syndrome (ACS) . The standard has been DAPT with aspirin AND a P2Y12 inhibitor ( clopidogrel , prasugrel, or ticagrelor ) for 12 months, with the option to extend for those at high thrombotic and low bleeding risk. …
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Ticagrelor
The risk of stopping ANTIplatelet drugs too soon
As a cardiovascular pharmacist, you may be asked about the risk of stopping aspirin, clopidogrel, or other antiplatelet drugs too soon. This applies to the many patients with cardiovascular disease taking aspirin to prevent a recurrent event, or aspirin plus clopidogrel for acute coronary syndrome or after a stent. Stopping these t…
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Surgery
How to manage ANTIplatelets around surgery
As a clinical pharmacist, you will be asked how to manage dual antiplatelet therapy (DAPT) around surgery in patients with a recent coronary stent. It’s a balancing act between risk of thrombosis and bleeding. American College of Cardiology guidelines still prefer at least 6 to 12 months of DAPT after most stent placements, but suggest shorter durations as an opti…
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Myocardial Infarction
Aspirin for PRIMARY prevention is different story
As a cardiovascular pharmacist, you will be asked whether "an aspirin a day" is still good for the heart, based on new U.S. Preventive Services Task Force recommendations. Help patients sort out the facts. This is a case of guidance catching up with the evidence... Recommend aspirin 81 mg/day for SECONDARY prevention , such as…
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TIA
Don’t use ticagrelor PLUS aspirin after stroke
As a hospital pharmacist, you will hear ticagrelor ( Brilique, Brilinta ) plus aspirin promoted after a MINOR ischemic stroke or high-risk TIA. New evidence shows that taking this combo for 30 days after a minor stroke or high-risk TIA decreases the composite of death or stroke in 1 in 91 patients, compared to aspirin monotherapy. But the benefit is mostly fro…
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Dual Antiplatelet Therapy
Limit bleeding risk in patients on triple antithrombotic therapy
How to manage patients on an anticoagulant (warfarin, etc) who also need antiplatelet medications ( aspirin , etc)? ㅡ Many patients end up on " triple antithrombotic therapy " such as warfarin for atrial fibrillation PLUS clopidogrel ( Plavix ) and aspirin after a stent. But bleeding risk is high. One in 50 patients will have a serious bleed in the first…
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TIA
Think of “ABCs” to optimize medications after stroke
Questions are coming up about reducing risk of RECURRENT ischemic stroke. Continue to focus on optimizing the “ABCs”. These key elements—Aspirin (or other antiplatelet agents), Blood pressure control, and Cholesterol management—are essential components in a robust strategy aimed at preventing subsequent strokes... Antithrombotics Recommend asp…
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Stroke
Antiplatelets options for recurrent ischemic stroke
Antiplatelets medications ㅡ The preferred options of antiplatelets for recurrent ischemic stroke are aspirin, clopidogrel ( Plavix ) or combination of aspirin and clopidogrel for short term then followed by EITHER aspirin or clopidogrel alone. Dipyridamole ER/aspirin ( Aggrenox ) can be used. Non-preferred options include aspirin plus ticagrelor ( Brilique ), Ticlop…
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PPIs
The interaction between PPI (omeprazole) and clopidogrel, what is your recommendations?
PRODIGY has published a guideline on antiplatelet treatment. This contains a scenario on the management of gastrointestinal adverse effects. This scenario discusses how to manage a patient at high risk of gastrointestinal bleeds. Ensure that general measures to reduce risk of gastrointestinal (GI) adverse effects have been taken... Prescribing …
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Stroke
Using TWO antiplatelets short-term after a minor stroke or transient ischemic attack
More patients will be discharged on a SHORT course of aspirin plus clopidogrel ( Plavix ) after a minor ischemic stroke or high-risk Transient Ischemic Attack (TIA). We know aspirin alone is generally used to prevent another stroke. But you'll see growing acceptance of DUAL antiplatelet therapy in these patients. It's already an option in guidelines based on …
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Hematology and Oncology
Is the combination of aspirin, clopidogrel, and warfarin appropriate and effective or inappropriate and too dangerous?
As a pharmacist, you will see warfarin ( Marevan ) used in combination with aspirin AND clopidogrel ( Plavix ) in more cardiac patients especially the elderly. Older patients are at higher risk for conditions that require two antiplatelet drugs plus anticoagulation. A common scenario is a patient who needs clopidogrel and aspir…
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Myocardial Infarction
Use "ABCDs" to optimize medications for stable coronary artery disease
Recent evidence suggests coronary stents don't improve chest pain more than optimal medications in patients with stable coronary artery disease. Remember these "ABCDs: A- antiplarelet; B- blood pressure; C- cholesterol; D- diabetes; S- symptom relief" to help manage patients with angina or who've had a heart attack more than a year ago... Anti…
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