Jansen Compass lecture Flashcards

1
Q

General rules

A

need to read the slides in their entirety. Cannot add to them or take away from them.

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2
Q

Slide 3 imagine of blood then a plque and rbc with thrombus and fibrin crosslinking

Three components of thromus

MOA of Xarelto

A

Atherosclerosis leads to thrombotic events. We know that ather is an inflammitory disease. Thrombi have 3 main components:

RBCs, fibrin, and plateletes

Xa –> prothrombin to thrombin –> thrombin binds PAR and activates plts agg.

Asa also adresses plt agg

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3
Q

What is the reach registry

how many country’s in ready

A

60,000 pts from all around the world with a hix of disease in one of the 3 major vascular meds –> brain, heart, or periphery. or had 3 or more risk factors. followed them witha goal of better understanding vasular events.

44

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4
Q

Reach definitions

  1. CAD
  2. Cerebral
  3. peripheral
  4. What were the 3 or more vascular risk factors that could get you in to reach
A
  1. Hx of documented cad, PCI, cabg, or MI
  2. CVD neurologist document hx of TIA or CVa
  3. PAD - one or both intermittent cluadicatio with abi M0.9 or or intermittent claudicationw ithan intervntion
  4. 15 or more cig per day, male > 65 or female > 70, intimal thickening > 2 carotid, carotid stenosis >=70%, SBP > 150, dm, HLD (bascially vascular disesae, +HLD, +HTN +/- age)
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5
Q

reach patients CV event at 1 and 3 years

how did they define cv event

A

if cad 15% at 1 year if pad 20% at 1 year. And 30% at 1 year and 40% at 3 years. eve

How would you–< MI stork, vascular death or rheosp for vascular event.

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6
Q

give percentages again in reach of a vascular event at 1 and 3 years

A
  1. 1 year 15% if CAD, and 20% if PAD; 3 year 20% cad and 40% pad.
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7
Q

if they ask what percent at 1 year and 3 years were on medication

A

90+ % at 1 and 3 years on at least 1 antithrombotic

90% at 1 and 3 on at least 1 anti hthn

70% and 75% at 1 and 3 year on lipid treatment

56% on asa mono

87 and 84 on at least one dm drug (for those who had dm.

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8
Q

What were the limb rates in reach at 4 years (4 years is random bc the other endpoints were 1 and 3 years)

A

4 years - 18% revasc and 4 amp. this is on guideline directed rx.

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9
Q

How does this compare to your clinic profile

A

Hx of CAD, PAD, CVA or > 65/70 +HTN +HLD or DM –> all of them!

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10
Q

In reach WP had polyvacsular disease

A

1 in 5 (20%) and if poly vascular disease had a 10% changed of death at 3 years. almost half had some type of event by year 3.

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11
Q

describe compass

A

2017 eikenboom 30K patients with hx of CAD, PAD or both . low dose asa alon vs. riva 5 mg alone vs. asa + riva 25.5 bid.

stopped early

primary endpoint MACCE cV death stork or MI (24% RRR and a 1.3% aRRR)

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12
Q

biggest improvement w compass

A

stroke rpevention almos tcut events in had 42%RRR RRR calculated using 1 -HR.

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13
Q

THM

A

there was a mortality benefit!!!!

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14
Q

I know what you are thinking why not just keep them on dapt after there MI?

A

two problems with this 1. ticagrelor was only studied longer term in post MI patients (so doesnt get a large swath of the patients covered in compass CAD or PAD or both and > 65 or less _ 2 risk factors). CAD without MI not covered. PAD not covered.

  1. Compositive was in favor. This shows pure mortality difference.
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15
Q

favorite slide

A

ALI table Cut rates of ALI in half as well as amp. that huge bc ALI careis a 25% mort.

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16
Q

bleeding in compas

A

Yes not no diff in fatal bleeding or bleeidng into critical organ. only differ was higher bleeding leading to hosp.