VOYAGER PAD: Live Long and Rivaroxaban

Dr. Jessica Carey discusses the VOYAGER PAD trial and antithrombotic management in PAD patients post-revascularization.

0:00-0:40: Intro

0:41-1:46: Introduction of Dr. Jessica Carey

1:47-5:52: VOYAGER PAD Overview

5:53-9:10: Previous management of PAD

9:11-11:18: PAD Interventions

11:19-13:49: Overall thoughts about VOYAGER PAD

13:50-15:19: Antithrombotic management of PAD

15:19-16:01: Closing

References:

  • VOYAGER PAD: Bonaca MP, Bauersachs RM, Anand SS, et al. Rivaroxaban in Peripheral Artery Disease after Revascularization. N Engl J Med 2020;382:1994-2004.
  • COMPASS: Anand SS, Bosch J, Eikelboom JW, et al. Rivaroxaban with or without aspirin I patients with stable peripheral or carotid artery disease: an international, randomized, double-blind placebo-controlled trial. Lancet 2018;391(10117):219-229.
  • CASPER: Bellch JJF, Dormandy J, et al. Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial. J Vasc Surg 2010;52:825-33.
  • Dutch BOA: Efficacy of oral anticoagulants compared with aspirin after infrainguinal bypass surgery (The Dutch Bypass Oral Anticoagulants or Aspirin Study): a randomized trial. Lancet 2000;355:346-51.
  • ATLAS-TIMI 51: Mega JL, Braunwald E, Wiviott SD, et al. Rivaroxaban in Patients with a Recent Acute Coronary Syndrome. N Engl J Med 2012;366:9-19.

The Caravaggio Trial: Painting DOACs into the Picture

Guest Dr. Paul Dobesh discusses the Caravaggio trial and DOAC use for VTE management in patients with cancer.

0:00-0:40: Intro
0:41-1:35: Introduction of Dr. Paul Dobesh
1:36-4:02: Caravaggio trial overview
4:03-7:08: Background of VTE antithrombotic management in cancer 7:09-9:09: Overall thoughts and where apixaban fits
9:10-10:42: ADAM-VTE Trial
10:43-13:36: Bleeding
13:37-14:37: PROBE trial design
14:38-15:47: Approach the VTE antithrombotic management in cancer patients
15:47-16:34: Closing

References:

  • Caravaggio trial: Agnelli G, et al. Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer.  N Engl J Med 2020;382:1599-1607. 
  • CLOT trial: Lee AY, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349(2):146-53.
  • ADAM VTE trial: McBane RD, et al. Apixaban, dalteparin, in Active Cancer Associated Venous Thromboembolism, the ADAM VTE Trial. Blood 2018;132(1):421. 
  • Hokusai VTE trial: Raskob GE, et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. N Engl J Med 2018;378(7):615-624. 
  • SELECT-D trial:  Young AM, et al. Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism: Results of a Randomized Trial (SELECT-D). J Clin Oncol 2018;36(20):2017-2023.

Popular, I know about POPular TAVI

0:00-0:40: Intro

0:41-1:25: Introduction of Dr. John Lindsley

1:26-5:57: POPular TAVI trial overview

5:58-8:35: Background of TAVI antithrombotic management

8:36-10-43: Intial thoughts about POPular TAVI

10:44-14:53: Study design

14:54- 17:22: Antithrombotic management

17:23-18:06: Closing

References

  • POPular TAVI Trial: Nijenhuis VJ, Brouwer J, Delewi R, et al.  Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation. N Engl J Med 2020; 382:1696-1707. DOI: 10.1056/NEJMoa1915152
  • ARTE Trial: Rodes-Cabau J, Masson J, Welsh RC, et al. Aspirin Versus Aspirin Plus Clopidogrel as Antithrombotic Treatment Following Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve: The ARTE (Aspirin Versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve Implantation) Randomized Clinical Trial. JACC Cardiovasc Interv. 2017 Jul 10;10(13):1357-1365.
  • GALILEO Trial: Dangas G, Tijssen JG, Wöhrle J, et al. A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve Replacement.
  • PARTNER Trial: Leon MB, Smith CR, Mack M, et al. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. N Engl J Med 2010; 363:1597-1607.
  • Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement in the Management of Adults With Aortic Stenosis: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2017;69(10):1313-46.

GUIDE-IT Guidance with Dr. Groo

Dr. Vicki Groo discusses the GUIDE-IT trial and medication titration in the heart failure with reduced ejection fraction (HFrEF) population.

0:00-0:40: Intro

0:40-1:27: Introduction of Dr. Vicki Groo

1:28-4:55: Introduction of GUIDE-IT trial and secondary analysis

4:56-7:56: Vicki’s Overall Thoughts

7:57-9:07: Approach to medication titration

9:08-10:31: What about newer HFrEF therapies?

10:32-12:09: Patient Education

12:10-14:07: Thoughts about reasoning for not uptitrating/adding HFrEF medications

14:08-14:37: HFrEF and Pharmacy Services

14:38-14:56: Final Thoughts

14:57-15:33: Closing

References:

  • Fiuzat M, Ezekowitz J, Alemayehu W, et al. Assessment of Limitations to Optimization of Guideline-Directed Medical Therapy in Heart Failure From the GUIDE-IT Trial A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol. Published online April 22, 2020. doi:10.1001/jamacardio.2020.0640
  • Greene SJ, Butler J, Albert NM, et al.  Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry. J Am Coll Cardiol. 2018 Jul 24;72(4):351-366. doi: 10.1016/j.jacc.2018.04.070.
  • Crespo-Leiro MG, Anker SD, Maggioni AP, et al. European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur J Heart Fail. 2016 Jun;18(6):613-25
  • Lombardi CM, Ferreira JP, Carubelli V, et al. Geographical differences in heart failure characteristics and treatment across Europe: results from the BIOSTAT-CHF study. Clin Res Cardiol. 2020 Jan 29. doi: 10.1007/s00392-019-01588-7.
  • Felker GM, Anstrom KJ, Adams KF, et al. Effect of Natriuretic Peptide–Guided Therapy on Hospitalization or Cardiovascular Mortality in High-Risk Patients With Heart Failure and Reduced Ejection Fraction A Randomized Clinical Trial. 2017;318(8):713-720. doi:10.1001/jama.2017.10565
  • Fiuzat M1Wojdyla DKitzman D, et al. Relationship of beta-blocker dose with outcomes in ambulatory heart failure patients with systolic dysfunction: results from the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial. J Am Coll Cardiol. 2012 Jul 17;60(3):208-15. doi: 10.1016/j.jacc.2012.03.023. Epub 2012 May 2.
  • Felker GM1Ahmad T2Anstrom KJ3, et al. Rationale and design of the GUIDE-IT study: Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure.  JACC Heart Fail. 2014 Oct;2(5):457-65. doi: 10.1016/j.jchf.2014.05.007. Epub 2014 Sep 3.
  • Samsky MD, Lin L, Greene SJ, et al. Patient Perceptions and Familiarity With Medical Therapy for Heart Failure. JAMA Cardiol. 2020;5(3):292-299. doi:10.1001/jamacardio.2019.4987
  • Bhat S, Kansal M, Kondos GT and Groo V. Outcomes of a Pharmacist-Managed Heart Failure Medication Titration Assistance Clinic. Ann Pharmacother. 2018;52(8):724-732.

The VICTORIA Trial

Dr. Kristen Pogue discusses the VICTORIA trial.

Episode Breakdown:

0:00-0:40: Intro

0:41-1:36: Introduction of Dr. Kristen Pogue

1:37-5:42: VICTORIA trial overview

5:43-8:18: Kristen’s initial thoughts

8:19-9:44: VICTORIA and PARADIGM-HF

9:45-12:17: How does this fit with DAPA-HF results?

12:18-14:14: Vericiguat in the Black population

14:15-15:45: Final thoughts

15:46-16:32: Closing

References:

  • VICTORIA Trial: Armstrong PW, Pieske B, Anstrom KJ, et al. Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2020. DOI: 10.1056/NEJMoa1915928.
  • PARADIGM-HF Trial: McMurray JJ, Packer M, Desai AS, et al. Angiotensin-Neprilysin Inhibition versus Enalapril in Heart Failure. N Engl J Med 2014;371:993-1004.
  • DAPA-HF Trial: McMurray JJ, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2019;381:1995-2008.
  • A-HeFT Trial: Taylor AL, Ziesche S, Yancy C, et al. Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart Failure. N Engl J Med 2004;351:2049-2057.

The Cold Truth of COLCOT

Dr. Toby Trujillo discusses the COLCOT trial.

Episode Breakdown:

0:00-0:40: Intro

0:41-1:30: Introduction of Dr. Toby Trujillo

1:31-3:56: COLCOT overview

3:57-4:50: Toby’s initial thoughts

4:51-6:08: Anti-inflammatory agents

6:09-7:09: Pneumonia?

7:10-8:29: Baseline Management of Patients

8:30-10:15: Who is the niche colchicine patient?

10:16-12:05: Drug burden and cost

12:06-13:03: Follow-up period

13:04-13:59: Final thoughts

14:00-14:44: Closing

References:

  • COLCOT Trial: Tardif J, Kouz S, Water DD, et al. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med 2019;381:2497-505.
  • CANTOS Trial: Ridker PM, Everett BM, Thuren T, et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med 2017;377:1119-31.
  • CIRT Trial: Ridker PM, Everett BM, Pradhan A, et al. Low-dose methotrexate for the prevention of atherosclerotic events. N Engl J Med 2019;380:752-62.
  • LoDoCo Trial: Nidorf SM, Eikelboom JW, Budgeon CA, Thompson PL. Low-dose colchicine for secondary prevention of cardiovascular disease. J Am Coll Cardiol 2013;61:404-10.

Return of the Lytics with Dr. Danielle Blais

Tune in as Dr. Danielle Blais discusses everything lytics.

References:

  • https://www.acc.org/latest-in-cardiology/articles/2020/03/18/15/07/poll-covid-19-and-interventional-cardiology
  • Welt FGP, Shah PB, Aronow HD, et al. Catheterization Laboratory Considerations During the Coronavirus (COVID-19) Pandemic: From American College of Cardiology’s (ACC) Interventional Council and the Society of Cardiovascular Angiography and Intervention (SCAI).  J Am Coll Cardiol  2020; DOI: 10.1016/j.jacc.2020.03.021
  • ISIS-2 Collaborative Group. Randomised Trial of Intravenous Streptokinase, Oral Aspirin, Both, or Neither among 17187 Cases of Suspected Acute Myocardial Infarction. The Lancet. 1988; 332(8607):349-360.
  • O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force of Practice Guidelines. J Am Coll Cardiol 2013; 61(4): DOI: 10.1016/j.jacc.2012.11.019
  • Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39(2):119-177. https://doi.org/10.1093/eurheartj/ehx393
  • Sabatine MS, Cannon CP, Gibson CM, et al. Addition of clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation (CLARITY). N Engl J Med 2005; 352:1179-1189
  • Chen ZMJiang LXChen YP, et al  Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial (COMMIT). Lancet. 2005 Nov 5;366(9497):1607-21.
  • Berwanger O, Lopes RD, Moia DF, et al. Ticagrelor Versus Clopidogrel in Patients with STEMI Treated with Fibrinolytic Therapy: TREAT Trial. J Am Coll Cardiol 2019;73:2819-28.
  • Wiviott ST, et al. Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndromes (TRITON). The N Engl J Med. 2007; 357(20):2001-2015. 
  • Antman EM, Morrow DA, McCabe CH, Murphy SA, Ruda M, Sadowski Z, Budaj A, López-Sendón JL, Guneri S, Jiang F, White HD, Fox KAA, Braunwald E, for the ExTRACT-TIMI 25 Investigators. Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction. N Engl J Med 2006;354(15):1477-1488
  • Guillermin A, Yan DJ, Perrier A, et al.  Safety and efficacy of tenecteplase versus alteplase in acute coronary syndrome: a systematic review and meta analysis of randomized trials. Arch Med Sci 2016;12:1181-1187.

Chlorthalidone vs. Hydrochlorothiazide: The Debate That Never Ends

Dr. Karen McConnell discusses a recent trial comparing chlorthalidone vs. hydrochlorothiazide for the treatment of hypertension.

0:00-0:40: Intro
0:41-1:51: Introduction of Dr. Karen McConnell
1:52-6:19: Trial overview
6:20-9:15: Karen’s Overall Thoughts
9:16-10:13: Trial Design 
10:14-10:54: Side Effect Differences
10:55-12:36: Choosing Between Chlorthalidone and HCTZ
12:37-14:03: Final Thoughts
14:04-14:49: Closing

References:

  • Hripcsak G, Suchard MA, Shea S, et al. Comparison of Cardiovascular and Safety Outcomes of Chlorthalidone vs Hydrochlorothiazide to Treat Hypertension. JAMA Intern Med 2020. doi: 0.1001/jamainternmed.2019.7454.
  • Lederle FA, Cushman WC, Ferguson RE, Brophy MT, Fiore LD. Chlorthalidone Versus hydrochlorothiazide: a new kind of Veterans Affairs cooperative study. Ann Intern Med 2016;165(9):663-4. doi: 10.7326/M16-1208.
  • Veterans Affairs Diuretic Comparison Project: https://clinicaltrials.gov/ct2/show/NCT02185417?cond=Diuretic+Comparison+Project&draw=2&rank=1
  • ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor of calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Tretment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288(23):2981-97.

Crushing ISCHEMIA with Dr. Barbara Wiggins

Dr. Barbara Wiggins joins the CardioScripts team to talk about the ISCHEMIA trial.

0:00-0:40: Intro
0:41-1:22: Introduction of Dr. Barbara Wiggins
1:23-5:26: Introduction of ISCHEMIA
5:27-6:37: Barbara’s Overall Thoughts
6:38-7:33: What does the ISCHEMIA trial add to COURAGE?
7:34-8:27: Patient Baseline Medication Regimens
8:28-10:42: ISCHEMIA Questions
10:43-11:51: ISCHEMIA Implications for Pharmacy Practice
11:52-14:03: Barbara’s Final Thoughts
14:04-14:48: Closing

References:

  • ISCHEMIA Trial: The ISCHEMIA Trial Home (https://www.ischemiatrial.org/)
  • COURAGE Trial: Boden WE, O’Rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med 2007;356:1503-16.

PIONEERing HF Care with Dr. Van Tassell

Dr. Ben Van Tassell discusses sacubatril-valsartan and the PIONEER-HF trial.

0:00-0:40: Intro
0:41-1:14: Introduction of Dr. Ben Van Tassell
1:15-4:00: Introduction of PIONEER-HF
4:01-5:22: Ben’s Initial Thoughts
5:23-6:40: Sacubatril-valsartan right out of the gate?
6:41-7:50: Thoughts on open-label expansion trial
7:51-11:12: Role of NT-proBNP as a surrogate endpoint
11:13-14:17: Cost considerations with sacubitril-valsartan
14:18-15:33: Patient follow-up in a real-world setting
15:34-16:13: Closing

References:

  • PIONEER-HF: Velazquez EJ, Morrow DA, DeVore AD, et al. Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure. N Engl J Med 2019;380:539-48.
  • PIONEER-HF open-label expansion: DeVore AD, Braunwald E, Morrow DA, et al. Initiation of Angiotensin-Neprilysin Inhibition After Acute Decompensated Heart Failure: Secondary Analysis of the Open-label Extension of the PIONEER-HF Trial. JAMA Cardiol 2020;5(2):202-207.
  • PARADIGM-HF: McMurray JJ, Packer M, Desai AS, et al. Angiotensin-Neprilysisn Inhibition versus Enalapril in Heart Failure. N Engl J Med 2014;371:993-1004.
  • Ibrahim NE and Januzzi JL Jr. Established and Emerging Roles of Biomarkers in Heart Failure. Circ Res 2018;123(5):614-29.