Up in Flames: Antiplatelet Therapy in Patients with Stable Ischemic Heart Disease Receiving Anticoagulation for A-fib

The optimal antithrombotic regimen in patients with AF and comorbid CAD remains unclear. Current American College of Cardiology/American Heart Association guidelines provide minimal guidance on whether to continue antiplatelet therapy in combination with anticoagulation in this population. Additionally, while the 2017 European Society of Cardiology guidelines recommend oral anticoagulation alone, there is little supporting evidence for this recommendation. This blog discusses the implications of the recently published AFIRE study, which attempts to answer the question: In patients with stable CAD and AF, is combination therapy necessary or is anticoagulation monotherapy sufficient?

A Tough Pill to Swallow: Clinical Application of Prasugrel in Patients with ACS

The recent results of The Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 trial have, to say the least, brought into question the notion that ticagrelor is a superior P2Y12 inhibitor in patients with ACS. This blog will briefly review the results of ISAR-REACT 5, but more importantly outline key considerations for the use of prasugrel in clinical practice.

3 Things You Should Know Before Throwing in the Towel on Triple Therapy

When it comes to triple therapy, the totality of the evidence strongly suggests “less is more”. While many practitioners have been quick to adopt dual antithrombotic therapy, it is important to consider the external validity of these trials and how we apply them to our patients. In this blog, Dr. Noel offers 3 considerations that require careful reflection before throwing in the towel on triple therapy.

Post-TAVR Antithrombotic Therapy: What To Do When No One Knows What To Do.

Transcatheter aortic valve replacement (TAVR) has proven to be an effective treatment option for patients with severe aortic stenosis at intermediate-high risk for complications with surgical aortic valve replacement. In spite of the growing popularity of TAVR, the optimal antithrombotic regimen remains unknown. This blog outlines current guideline recommendations for post-TAVR antithrombotic therapy and gives guidance on how to handle special populations and patient-specific factors.

Aspirin for Primary Prevention: Have We ARRIVEd at an Answer?

Evidence from multiple recent trials has brought to question the role of aspirin for primary prevention of cardiovascular disease. This remains common practice in the United States, despite questionable data to identify a population for whom the benefits outweigh the risks. In this blog, I compare recent evidence to current guideline recommendations and speculate whether or not aspirin will have a role for this indication in the future.

Treat the Patient, Not the Number: Stroke Prevention in Atrial Fibrillation with Low CHA2DS2-VASc Scores

Although guidelines for the management of atrial fibrillation advocate for anticoagulation in patients with a high stroke risk (CHA2DS2-VASc score of 2 or greater), the recommendations for patients at low (CHA2DS2-VASc 0) and in particular intermediate (CHA2DS2-VASc 1) risk of stroke are less clear. In this blog, we discuss antithrombotic strategies in these latter two subgroups.

Upstream P2Y12 Inhibitors and the CABG Quandary

Given the extensive role that platelet activation and aggregation play in the pathophysiology of acute coronary syndromes, it seems reasonable to administer a P2Y12 inhibitor as early as possible to minimize thrombus formation and progression of ischemia. Nonetheless, there remains considerable controversy surrounding the optimal timing of P2Y12 inhibitor administration in those undergoing percutaneous coronary intervention. In this blog, we’ll explore the data for and against early P2Y12 inhibitor administration in those presenting with non-ST-segment-elevation acute coronary syndromes and how coronary artery bypass graft surgery should, or should not, impact the decision for when to administer P2Y12 inhibitors.