CCS 2023 - Antiplatelet Flashcards
d/c APT avant CABG
Tica: 2-3 j
Plavix: 2-7j
DAPT post-CABG - No ACS
1 an DAPT avec PLAVIX
HBR: considérer SAPT
DAPT post-CABG - ACS
1 an DAPT avec Tica > prasu > plavix
HBR: considérer 1-3 mois DAPT puis SAPT
DAPT post-CABG - Aco
ACO + SAPT or ACO + noAPT
Off pump - DAPT effects
Reduces MACE (ACS or elective)
Improves graft patency
On pump - DAPT effects
Improves graft patency
(no effect on MACE)
PCI or ACS with AFib - Regimen
NACO + DAPT for 1-30 days then drop ASA
Never more than 30 days: increased bleeding
AFib - No PCI or ACS for 12 months
NACO seul
Bleeding avoidance strategies
Avoid NSAIDS
Avoid GpIIbIIIa
Radial approach
NACO with DAPT
Apixaban 5 mg BID
Xarelto 15 mg die
Dabigatran 150 mg BID
Edoxaban 60 mg die
Warfarine INR 2-2.5
NACO reduced doses
Eliquis 2.5 md BID: 2/3 <60 kg, >80 ans or >133 umol/L
Edoxaban 30 mg: <60 kg, CrCl 15-50 cc/min or potent P-glycoprotein inhibitors
Xarelto 15 mg die: if 30-50 ml/min (vs 10 mg en trithérapie)
P-glycoprotein inhibitors
AAA: amiodarone, quinidine
ATB: clarithromycin, erythromycin, ketoconazole
BCC: diltiazem, verapamil
IPP: lansoprazole, omeprazole
ISRS: paroxetine, sertraline
Autres: ciclosporin, colchicine, tamoxifen
Choix de APT si ACS
HBR 1-3 mois: Tica - Prasu - Plavix
1 an: Tica - Prasu > Plavix
3 ans: Tica 60 bid - Plavix > Prasu
Choix APT si elective PCI
PLAVIX (loading dose 600 mg sauf TNK)
HBR Regimen
1-3 months DAPT with potent if ACS or plavix
THEN:
Downgrade potent -> plavix or SAPT with P2Y12 inhibitor
Pre-treatment P2Y12 - Timing
STEMI: yes to all
NSTEMI >24h coro: yes
NSTEMI <24h coro: no
Elective coro: no
Planned PCI: at least 2h before
Reasonable not to give if suspected surgical anatomy
Pre-treatment P2Y12 - Molecule
STEMI: Prasu or Tica > Plavix
NSTEMI >24h: Tica or Plavix
NSTEMI <24h: upon PCI Prasu or TIca > plavix
(Avoid prasu when anatomy not known)
