In Zac Noel we ENTRUST: Double or Nothing?

In this episode, Dr. Zac Noel helps us navigate through the ENTRUST-AF PCI trial as well as dual vs. triple antithrombotic therapy.



0:00-0:40: Intro
0:41-1:42: Introduction of Dr. Zachery Noel
1:43-4:35: ENTRUST-AF PCI Overview
4:36-5:46: Zac’s Overall Thoughts
5:47-6:33: Dual antithrombotic therapy for everyone?
6:34-7:38: Patient population in ENTRUST-AF PCI
7:39-9:03: Other P2Y12 inhibitors
9:04-10:13: Ischemic outcomes
10:14-11:18: Who should receive dual antithrombotic therapy?
11:19-14:28: Zac’s Final Thoughts
14:29-15:38: Closing/New Year’s Resolutions


References:

  • ENTRUST AF-PCI: Vranckx P, Valgimigli M, Tijssen J, et al. Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST-AF PCI): a randomised, open-label, phase 3b trial. Lancet 2019;394(10206):1335-43.
  • AUGUSTUS: Lopes RD, Heizer G, Aronson R, et al. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. N Engl J Med 2019;380(16):1509-24. 
  • PIONEER AF-PCI: Gibson CM, Mehran R, Bode C, et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2019;375(25):2423-34.
  • RE-DUAL: Cannon CP, Bhatt DL, Oldgren J, et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation.  N Engl J Med 2017;377(16):1513-1524.
  • WOEST: Dewilde WJ, Oirbans T, Verheugt FW, et al. Lancet 2013;381(9872):1107-15.
  • Dual vs. Triple Antithrombotic Therapy Meta-Analysis: Lopes RD, Hong H, Harskamp RE, et al. Safety and Efficacy of Antithrombotic Strategies in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Network Meta-analysis of Randomized Controlled Trials. JAMA Cardiol 2019;4(8):747-55.

Entering the TWILIGHT Zone

Prepare to dive into the TWILIGHT trial with Dr. Craig Beavers.

0:00-0:22: Intro
0:23-1:01: Introduction of Dr. Craig Beavers
1:02-3:32: TWILIGHT Overview
3:33-6:31: Craig’s Overall Thoughts
6:32-8:39: Excluded Patients
8:40-10:17: Ticagrelor Monotherapy and Ischemic Outcomes
10:18-12:52: TWILIGHT and GLOBAL LEADERS
12:53-14:24: Final Thoughts
14:25-15:22: Closing/Craig’s Upcoming Podcast

References:

  • TWILIGHT: Mehran R, Baber U, Sharma SK, et al. Ticagrelor with or without Aspirin in High-Risk Patients after PCI. N Engl J Med 2019;381:2032-2042.
  • GLOBAL LEADERS: Vranckx P, Valgimigli M, Juni P, et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet 2018;392:940-49.

Episode is Live

Published: Dec. 24, 2019 @ 4AM EditUnpublish

Been there, done that: Expert advice from parting RPDs (Part 2)

In the second of two episodes, Drs. Rob DiDomenico and Kerry Pickworth provide their expertise about PGY2 Cardiology residency training.

0:00-0:40: Intro
0:41-2:46: Physical exam in the cardiology setting
2:47-6:17: Importance of interpreting diagnostic tests
6:18-9:02: Keeping up with literature
9:03-11:29: Importance of self-reflection
11:30-15:00: Final thoughts/Free time (?)

References:

Been there, done that: Expert advice from parting RPDs (Part 1)

In the first of two episodes, Drs. Rob DiDomenico and Kerry Pickworth provide their expertise about Midyear for prospective PGY2 Cardiology residency candidates. 

0:00-0:40: Intro
0:41-2:22: Introduction of Drs. Rob DiDomenico and Kerry Pickworth
2:23-3:17: Overview of PGY2 Cardiology Pharmacy Resident Training Opinion Paper
3:18-4:56: Rob and Kerry’s Overall Thoughts
4:57-9:08: Midyear Advice/What are you looking for in a candidate?
9:09-11:42: What if the candidate has limited cardiology experience?
11:43-13:49: Why ambulatory care if a preference for critical care cardiology?
13:50-14:59: Closing

References:

Episode 3: How sweet it is to be an SGLT2 Inhibitor

0:00-0:46: Intro
0:47-1:20: Introduction of Dr. Ted Berei
1:21-2:57: DAPA-HF Overview
2:58-6:12: Ted’s Overall Thoughts
6:13-7:24: DAPA-HF Patient Population
7:25-9:15: Sacubitril/valsartan or Dapagliflozin First?
9:16-10:47: Considerations Prior to Starting SGLT2 Inhibitors
10:48-12:19: SGLT2 Inhibitors and Cost
12:20-14:43: Final Thoughts
14:44-15:42: Closing/Introduction to Finn


References: 

  • DAPA-HF: McMurray JJ, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2019; DOI: 10.1056/NEJMoa1911303
  • CANVAS: Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med2017;377:644-57.
  • EMPA-REG: Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015;373:2117-28.
  • DECLARE-TIMI 58: Wiviott SD, Bonaca MP, Kato ET, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2019;380:347-57.
  • 2018 ACC Expert Consensus Decision Pathway for Type 2 Diabetes and Atherosclerotic Cardiovascular Disease: Das SR, Everett BM, Birtcher KK, et al. 2018 ACC Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease. J Am Coll Cardiol 2018;72(24):3200-23.
  • Type 2 Diabetes and Heart Failure: Dunlay SM, Givertz MM, Aguilar D, et al. Type 2 Diabetes Mellitus and Heart Failure: A Scientific Statement From the American Heart Association and the Heart Failure Society of America. Circulation 2019;140:e294-e324.
  • Packer MP, Anker SD, Butler J, et al. Effects of Sodium-Glucose Cotransporter 2 Inhibitors for the Treatment of Patients With Heart Failure: Proposal of a Novel Mechanism of Action. JAMA Cardiol2019;2(9):1025-29.
  • Butler J, Hamo CE, Filippatos G, et al. The potential role and rationale for treatment of heart failure with sodium-glucose co-transporter 2 inhibitors. Eur J Heart Fail 2017;19(11):1390-1400.
  • Ha CM and Wende AR. The Growing Case for Use of SGLT2i in Heart Failure: Additional Benefits of Empagliflozin in a HFpEF Rodent Model. JACC Basic Transl Sci 2019;4(1):38-40.

Episode 2: REACT(5)ion from Steve Dunn

In this episode, we review the ISAR-REACT 5 trial and hear Dr. Steve Dunn’s thoughts about how this trial fits into P2Y12 management in patients with acute coronary syndromes. 

Episode:
0:00-0:40: Intro
0:41-1:23: Introduction of Dr. Steve Dunn
1:24-3:42: ISAR-REACT 5 Overview
3:43-6:28: Steve’s Overall Thoughts
6:29-7:59: Context of ISAR-REACT 5
8:00-9:34: Study Funding
9:35-11:25: Study Discontinuation Rate
11:26-12:50: Secondary Safety Outcomes
12:51-15:51: Final Thoughts
15:52-16:50: Closing/Podcast Recording Location Discussion

References:

  • ISAR-REACT 5: Schüpke S, Neumann F, Menichelli M, et al. Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes. N Engl J Med 2019;381:1524-1534.
  • TRITON-TIMI: Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med 2009;357:2001-2015.
  • PLATO: Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med 2009;361:1045-1057.
  • PRAGUE-18: Motovska Z, Hlinomaz O, Miklik R, et al. Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Multicenter Randomized PRAGUE-18 Study. Circulation 2016;134(21):1603-1612.
  • TRILOGY-ACS: Roe MT, Armstrong PW, Fox KA, et al. Prasugrel versus Clopidogrel for Acute Coronary Syndromes without Revascularization. N Engl J Med 2012;367:1297-1309.
  • ACCOAST: Montalescot G, Bolognese L, Dudek D, et al. Pretreatment with Prasugrel in Non–ST-Segment Elevation Acute Coronary Syndromes. N Engl J Med 2013;369:999-1010.

CardioScripts Upcoming Podcast Episodes

REACT(5)ion from Steve Dunn: Feeling conflicted about which P2Y12 inhibitor to use since ISAR-REACT 5 was released? Listen to Steve’s REACT(5)ion here first!

How sweet it is to be an SGLT2 Inhibitor: Listen to Dr. Ted Berei’s thoughts about dapagliflozin use in patients with heart failure and reduced ejection fraction.

Entering the TWILIGHT Zone: In this episode, we’ll talk to Dr. Craig Beavers about his thoughts on the TWILIGHT trial and discuss his aspiring future podcast combining cardiology with pop culture! Anticipated release of 2024…

In Zac Noel we ENTRUST: Double or Nothing?: A few recent trials have evaluated triple antithrombotic therapy vs. dual antithrombotic therapy in patients with ACS/PCI and AF. In this episode, we put our full (en)TRUST in Dr. Zac Noel as he helps us navigate this complex clinical conundrum.

“Been There, Done That”- Expert Advice From Parting RPDs: In this special two-part episode former Cardiology Residency Program Director Tracy Macaulay, interviews Dr. Kerry Pickworth and Dr. Robert Didomenico, former RPDs at Ohio State and University of Illinois at Chicago, respectively.  Words of wisdom are pulled from a recently published opinion paper on recommendations for training cardiovascular pharmacy specialists and tricks on finding the right match this recruitment season. 

Episode 1: Heart on AFIRE, Strong Desire to Stop Aspirin

In this episode, we interview Dr. Tracy Macaulay about the AFIRE trial and hear her thoughts on the role of aspirin in patients with atrial fibrillation and stable coronary disease. 

Episode:
0:00-1:38: Intro
1:39-2:35: Introduction of Dr. Tracy Macaulay
2:36-5:19: AFIRE Trial Overview
5:20-7:14: Initial Thoughts
7:15-10:07: AFIRE Population and Rivaroxaban Dosing
10:08-11:06: Dropping Aspirin
11:07-12:11: What about other anticoagulants?
12:12-13:38: Final Thoughts
13:39-14:50: Closing/Discussion of Funding

References:

  • AFIRE Trial: Yasuda S, Kaikita K, Akao M, et al. Antithrombotic therapy for atrial fibrillation with stable coronary disease. N Engl J Med 2019;381:1103-1113.
  • OAC-ALONE Trial: Matsumura-Nakano Y, Shizuta S, Komasa A, et al. Open-label randomized trial comparing oral anticoagulation with and without single antiplatelet therapy in patients with atrial fibrillation and stable coronary artery disease beyond 1 year after coronary stent implantation: OAC-ALONE Study. Circulation 2019; 139:604–616. 
  • WARIS-II Trial: Hurlen M, Abdelnoor M, Smith P, et al. Warfarin, Aspirin, or Both after Myocardial Infarction. N Engl J Med 2002;347:969-974.
  • J-ROCKET AF Study: Hori M, Matsumoto M, Tanahashi N, et al. Rivaroxaban vs. warfarin in Japanese patients with atrial fibrillation — the J-ROCKET AF Study. Circ J 2012;76:2104-11.
  • Other: Tanigawa T, Kaneko M, Hashizume K, et al. Model-based dose selection for phase III rivaroxaban study in Japanese patients with non-valvular atrial fibrillation. Drug Metab Pharmacokinet 2013;28:59-70.

CardioScripts Trailer

Feel like something’s missing? Looking for a way to keep up-to-date with cardiology literature? Then you are listening to the right podcast! CardioScripts is a cardiology pharmacy podcast intended to help keep you up-to-date in a fun, engaging, and efficient manner. Join hosts Tracy Macaulay and Liz Sulaica as they interview cardiology pharmacy experts across the country!