Go with the (Blood) Flow: Antithrombotic Therapy After PCI and De-Escalation of Antiplatelet Therapy After PCI


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This week’s episode of The Rounds Table is all about anticoagulation. Kieran Quinn and Mike Fralick cover two important studies: the latest evidence on antithrombotic therapy after percutaneous coronary intervention (PCI) and de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing PCI.

In patients with acute coronary syndrome undergoing PCI, can platelet function testing identify patients where treatment can be de-escalated from prasugrel to clopidogrel? Mike covers the TROPICAL-ACS trial. The greater anti-ischemic benefit of the the newer and more potent antiplatelet agents, such as prasugrel, occurs early in treatment in comparison to clopidogrel. The increased risk of bleeding with the newer agents typically occurs during chronic treatment. An approach to guided de-escalation is thus warranted.

Next, Kieran covers the latest randomized controlled trial on antithrombotic therapy after PCI. Triple antithrombotic therapy with anticoagulation plus two antiplatelet agents is the standard of care after PCI for patients with atrial fibrillation, but this therapy is associated with a high risk of bleeding. Is there a better approach? Kieran breaks it down for listeners.

Finally, the Good Stuff segment. Mike shares an article on the inappropriate use of the drug, Neudexta, in nursing homes. Kieran shares an article on predatory journals here in North America.

If you like what you hear, rate us on iTunes! Chat with us on Twitter @roundstable and tweet at Kieran @kieranlquinn and Mike @FralickMike.

The Papers

1. TROPICAL-ACS: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32155-4/abstract

2. Triple Therapy: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1708454

Good Stuff

1. Nuedexta: http://www.cnn.com/2017/10/12/health/nuedexta-nursing-homes-invs/index.html

2. Predatory research journals: http://www.cmaj.ca/content/189/42/E1322.short?rss=1

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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