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.

Spironolactone: TOPCAT or underdog?

0:00-0:40: Intro
0:41-1:22: Introduction of Dr. Kathleen Faulkenberg
1:23-5:45: Overview of TOPCAT
5:46-8:28: Kathleen’s Overall Thoughts 
8:29-10:11: TOPCAT Controversy
10:12-11:15: Spironolactone Metabolite Differences Between Regions
11:16-11:59: More Questions Around TOPCAT
12:00-12:51: What do we do with results from TOPCAT?
12:52-15:19: Final Thoughts
15:20-16:01: Closing


References:

  • TOPCAT: Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for Heart Failure with Preserved Ejection Fraction. N Engl J Med 2014;370:1383-92.
  • de Denus S, Desai AS, Leclair G, et al. Spironolactone Metabolites in TOPCAT – New Insights into Regional Variation. N Engl J Med 2017;376:1690-1692.
  • Pfeffer MA, Claggett B, Assmann SF, et al. Regional variation in patients and outcomes in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. Circulation 2015;131(1):34-42.
  • Cohen JB, Schrauben SJ, Zhao L, et al. Clinical Phenogroups in Heart Failure With Preserved Ejection Fraction: Detailed Phenotypes, Prognosis, and Response to Spironolactone. JACC Heart Fail 2020; DOI: 10.1016/j.jchf.2019.09.009.