March 28, 2023

Guidelines, Statins and Clopidogrel

Well after a busy week at the european society of cardiology meeting we have a good roundup of top studies this week at the number three spot i’m going to put actually for guideline updates from the european society of cardiology these span several important areas including atrial fibrillation where one of the big updates was a shift in the anti thrombotic therapy

For chad’s score one patient so the lower risk patients the european guideline now says that warfarin is preferred over aspirin in that low risk population whereas previous guidelines that said it was an equal choice between that and aspirin also dronedarone was added as a treatment for atrial fibrillation then in the revascularization guidelines they added tyco

Egg roll or which is not yet approved by regulatory authorities but under consideration but that becomes a another choice in one with a clinical advantage over standard dose clopidogrel for patients with acs and especially undergoing pci there are also guidelines for grown-up congenital heart disease or gooch as it’s known in the european guideline and finally

One on cardiac resynchronization and device therapy at the number two spot we have a meta-analysis published as an expedited publication in jack where tony bathery and colleagues reviewed all of the pre procedure staten studies looking both pre pci but also pre cabbage and prior to noncardiac surgery together they found 21 published studies and found a very large

Reduction in post procedure am i that is a forty three percent reduction highly significant by giving statins prior to the procedure and so while we all think about beta blockade and now have to you know balance the timing of that that there’s another class of drugs really that we should think about in the preoperative evaluation of patients at the number one spot

Is the long-awaited publication of the current oasis seven trial this was actually co-published the main trial in the new england journal and the pci subset published in lancet and this study looked at double dose clopidogrel a six hundred milligram load and 150 milligrams a day for one week followed by the regular 75 milligrams a day as compared with standard

Dosing of 300 milligram load in 75 a day overall the trial found no advantage of the double dose clopidogrel but in the pci subset did find an advantage with about a seventeen percent lower risk of cardiovascular death and meijer stroke and a lower risk of stent thrombosis and so many caveats debated here but many physicians have taken this to be a reason to use

Higher dose clopidogrel if that’s the drug of choice for pci patients but there are other alternatives as noted in the european guidelines take a growler and also prasugrel and so in the editorial different scenarios are played out for which patients to get which drug and will have to await the guideline update to see where that sorts out in the accha guidelines

The study also looked at dosing of aspirin regular 3 25 milligram doses 75 milligrams a day and found overall no difference in the risk of cardiovascular events or of bleeding for that matter over a 30 day period there was a lower risk of gi bleeding with the low-dose aspirin and so these data also will need to get incorporated into the guidelines in terms of

Optimal aspirin dosing so a big week and that’s what we have for the party source news roundup i’m chris cannon you

Transcribed from video
Cardiology Countdown | Guidelines, Statins and Clopidogrel By American College of Cardiology Video Archive