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Antithrombotics Antiplatelets Flashcards

1
Q

Antidote of Dabigatran

A

Idarucizumab

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2
Q

Non valvular Afib means

A

AF in absence of RHD,Prosthetic valve, MVrepair- ACC AHA 2011

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3
Q

Exclusion criteria in RELY trial

A

Prosthetic valve or hemodynamically relevant valve disease

In ROCKET AF-Prosthetic valve Or significant MS excluded

ARISTOTLE-Moderate to Severe MS and Prosthetic valve excluded

DRA in that order

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4
Q

Interaction b/w Digoxin and Amiodarone

A

Increases Digoxin levels

Reduce dose by 50%

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5
Q

Interaction b/w Digoxin And Warfarin

A

Digoxin increases INR

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6
Q

Food increases the bioavailability of which NOAC

A

Rivaroxaban -with food 100% and without 66%

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7
Q

Half life of Alteplase

A

3-4 mts

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8
Q

The tissue plasminogen activator is

A

rTPA- Alteplase

Reteplase is nonglycosylated form of rTPA- it is known as rPA

Tenecteplase is a multipoint (3 point mutations) mutant of rTPA has longer half life

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9
Q

Half life of Alteplase

A

3-4 mts

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10
Q

The tissue plasminogen activator is

A

rTPA- Alteplase

Reteplase is nonglycosylated form of rTPA- it is known as rPA

Tenecteplase is a multipoint mutant of rTPA has longer half life

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11
Q

Half life of Alteplase

A

3-4 mts

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12
Q

The tissue plasminogen activator is

A

rTPA- Alteplase

Reteplase is nonglycosylated form of rTPA- it is known as rPA

Tenecteplase is a multipoint mutant of rTPA has longer half life

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13
Q

USPSTF recommends Aspirin for

A

> 50 yrs with >10% risk

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14
Q

Non thienopyridine P2Y12 inhibitors

A

Ticagrelor, Cangrelor

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15
Q

Dabigatran phase 3 trial was published in

A

2009

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16
Q

NOAC indicated if CHADS2 Vasc score is

A

2

If score is 1 it can be considered

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17
Q

NOAC -Efficacy wise best p value is…

Safety wise best p value is….

A

Dabigatran

Safety- Apixaban

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18
Q

4 studies on NOAC plus anti platelet

A
  1. PIONEER AF PCI- Rivoroxaban
  2. RE -DUAL PCI- Dabigatran
  3. ENTRUST AF PCI- Edoxaban
  4. AUGUSTUS-Apixaban

Last 3 ongoing studies as of 09/2017

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19
Q

Which trial showed Rivaroxaban reduced mortality post ACS

A

ATLAS ACS -2 TIMI 51

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20
Q

How to load Ticagrelor after Clopidogrel acute setting

A

180 mg
Irrespective of time and dose of Clopidogrel

If other way round loading Clopidogrel after Tica is 600mg AFTER 24 Hours of Tica

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21
Q

Interchange between Prasu and Clopidogrel in acute setting

A

Prasu 60 mg irrespective of Clopidogrel timing and dose

Clopidogrel loading 600mg AFTER 24 Hours of Prasu

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22
Q

Interchange between Prasu and Tica in acute setting

A

Tica 180 24 hours after Prasu

Prasu 60 24 hours after Tica

Same either way

ESC 2017

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23
Q

How to switch between Clop,Prasu,&;Tica in chronic setting

A

After Tica 24 hrs after loading dose load both clop and Pras

No loading for Tica

Between Clop and Pras . No loading dose . Normal dose after 24 hrs

In acute setting always give loading dose

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24
Q

Use of NOAC is discouraged in which VHD

A

Moderate-Severe Mitral stenosis

ESC 2017

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25
Q

Use of NOAC in AS/AR/MR

ESC 2017

A

IIa recommendation

26
Q

GUSTO moderate bleeding criteria

A

Any bleeding which needs blood transfusions

Severe is IC Bleed & Any bleed which needs intervention For hemodynamic compromise

All others -Mild

27
Q

Clopidogrel is the default antiplatelet post PCI only in

A

Stable CAD & Along with Oral anticoagulation

ESC 2017

28
Q

Duration of DAPT in stable CAD

A

DES And BMS - both 1-6 monthsw

ESC2017

29
Q

Duration of DAPT after ACS

A

12 months

6 months- If bleeding risk high

> 12 months-if ischemic Risk high

ESC2017

30
Q

Duration of DAPT is not decided by stent type::This conclusion was by

31
Q

Duration of triple therapy after ACS if required is for

A

Only 6 months

ESC 2017

32
Q

After Stenting (DES/BMS) Surgery is permitted after

A

1 month- If Aspirin can be continued

If both has to be stopped, bridge with

Cangrelor, Tirofiban or Eptifibatide

ESC 2017

33
Q

Post CABG antiplatelets(after ACS)

A

DAPT for 1year

But role of DAPT after CABG for stable CAD is uncertain

ESC 2017

34
Q

Triple therapy increases bleeding risk by

35
Q

Cangrelor half life and duration of action

A

10 mts- half life

2 hours- platelet function becomes normal

36
Q

Tenecteplase is administered over

37
Q

Position of Bivalirudin after ESC 2017

A

Downgraded from Class I To II a

38
Q

Role of RBBB and LBBB in urgent CAG -ESC 2017

39
Q

The ESC 2017 change in paradigm on DAPT

A

“DAPT is a regimen to treat the patient and not the previously implemented stent”

Ie individual patient’s ischemic risk versus bleeding risk

40
Q

ESC 2017 recommendation on DAPT

A

12 months irrespective of revasc strategy

6 mon- If bleeding risk high

More than 12 mon - consider if no bleeding compln in 12 months

41
Q

Addition of DAPT to OAC increase bleeding risk by

A

2-3 fold

ESC 2017

Duration of DAPT maximum should be 6 months

Use only Clopidogrel

42
Q

Default P2Y12 in stable CAD treated with PCI

A

Clopidogrel

For ACS

43
Q

Definition of HTN in CHADS2 VASc

A

BP >140/90 on at least two occasions

44
Q

Definition of stroke in CHADS2 VASc score

A

Includes any thromboembolism also

45
Q

Definition of Vascular disease in CHADS2 VASc score

A

MI, PAD, Aortic plaque

46
Q

Varying coupling interval in VPCs indicate

A

Parasystole( not an extrasystole)
Two independent pacemakers functioning asynchronously . Can happen with extra systole also

If coupling interval is constant it means it’s a VPC arising from the same focus

47
Q

Anticoagulant effect of Apixaban lasts for……..after last dose

A

24 hours - ie about 2 half lives

No established way to reverse the effect

48
Q

When will you reduce the dose of apixaban to 2.5 mg BD

A
  1. Wt less than 60kg
  2. Creatinine-1.5
  3. Age-80
49
Q

DAPT+ OAC increases bleeding complications by ……… times

A

2-3 Times compared to DAPT alone

50
Q

Duration of triple therapy if indicated

A

Max 6 months or till Hospital discharge

51
Q

Default P2Y12 in PCI

A

Stable CAD- Clopidogrel

ACS- Tica or Prasu

Triple therapy- Clopidogrel

ESC 2017

52
Q

Risk factors for increased bleeding with DAPT

A

Prior h/o bleeding

Female ,Elderly,CRF

53
Q

2015 PEGASUS trial is about

A

Ticagrelor in pts with prior MI- long term use

54
Q

Studies which showed one month DAPT can be used in DES treated patients with better results than BMS

A

LEADERS FREE

ZEUS

55
Q

Risk scoring tool for DAPT bleeding risk

A

PRECISE DAPT 2017

56
Q

Direct acting P2Y12 inhibitors

A

Ticagrelor And Cangrelor

57
Q

Difference in changing from Prasugrel to Ticagrelor in Early and Late (>30days) phase

A

In early phase- After 24 hrs of last Prasugrel- LD 180 mg

Late phase- After 24 hrs of last Prasugrel - 90 mg BID- MD

58
Q

Prasugrel should be stopped how many days before surgery

Ticagrelor

Clopidogrel

A

P-7 days

Others- 5 days

59
Q

How to change from Ticagrelor to Clopidogrel

A

600 mg LD-24 hrs after last T dose

Both in Early and Late phase

60
Q

In the late ( more than 30 days after index event)clop/ prasu/ Tica switch :-loading dose is used only when

A
  1. Tica changed to Clopidogrel or
  2. Tica changed to Prasugrel

24 hrs from last Tica dose
600mg and 60 mg respectively

All other late switching is easy- Maintanence dose after 24 hrs

61
Q

Early phase (30 days or less from index event)antiplatelet switching

A

For all it’s same. Give loading dose after 24 hours

62
Q

Triple therapy strategy used in RE DUAL PCI trial

A

BMS- After 1 month Aspirin was stopped
DES-After 3
months Aspirin was stopped

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