disease state platelet presentation volume 2 presented by: name
Post on 29-Dec-2015
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Case Study: Pre-Angiogram
• Lesion in the Lesion in the mid LADmid LAD
• Proceeded with Proceeded with PCIPCI
• PCI SuccessfulPCI Successful
• Post PCI MedsPost PCI Meds• ACE inhibitorACE inhibitor
• Beta-blockerBeta-blocker
• StatinStatin
• Dual antiplatelet Dual antiplatelet therapytherapy
Case Study: Post-Angiogram
Post PCI Arterial Environment
Arterial wall damage and plaque disruption
Exposure of thrombotic substrates
SMCSMC
Dual Antiplatelet Therapy in the PCI Patient
Manages the prothrombotic environmentManages the prothrombotic environment
Reduces risk of MI and deathReduces risk of MI and death
Platelet Platelet MonolayerMonolayer
The Progression of Atherosclerotic Disease Continues
Plaque formation is likely to continue in this ACS patientPlaque formation is likely to continue in this ACS patient
Premature Discontinuation of Dual Antiplatelet Therapy
Increased risk of MI and deathIncreased risk of MI and death
Minimizing the Risk of Atherothrombotic Events in the ACS patient
• PPercutaneous ercutaneous CCoronary oronary IInterventionntervention
• Long-term medical managementLong-term medical management
•Dual antiplatelet therapyDual antiplatelet therapy
• Lifestyle changesLifestyle changes
Smith SC Jr, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). American Heart Association Website. Available at: http://www.americanheart.org.
Dual Antiplatelet Therapy Continued
in this ACS Patient
Platelet monolayer is formed and activation is better managed
Managing the Risks: A Summary
Long term dual antiplatelet therapy Long term dual antiplatelet therapy helps prevent atherothrombosis caused byhelps prevent atherothrombosis caused by
PCI and spontaneous plaque rupturePCI and spontaneous plaque rupture
ACC/AHA/SCAI 2005 Guidelines for PCI
Current guidelines recommend dual Current guidelines recommend dual antiplatelet therapy be given ideally up to antiplatelet therapy be given ideally up to
12 months in patients who have undergone 12 months in patients who have undergone PCI and who are not at a high risk of bleeding.PCI and who are not at a high risk of bleeding.
Smith SC Jr, Feldman TE, Hirschfeld JW Jr, Jacobs AK, Kern MJ, King SB III, Morrison DA, O’Neill WW, Schaff HV, Whitlow PL, Williams DO. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). American Heart Association Website. Available at: http://www.americanheart.org.
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