Jansen Compass lecture Flashcards
General rules
need to read the slides in their entirety. Cannot add to them or take away from them.
Slide 3 imagine of blood then a plque and rbc with thrombus and fibrin crosslinking
Three components of thromus
MOA of Xarelto
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
What is the reach registry
how many country’s in ready
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
Reach definitions
- CAD
- Cerebral
- peripheral
- What were the 3 or more vascular risk factors that could get you in to reach
- Hx of documented cad, PCI, cabg, or MI
- CVD neurologist document hx of TIA or CVa
- PAD - one or both intermittent cluadicatio with abi M0.9 or or intermittent claudicationw ithan intervntion
- 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)
reach patients CV event at 1 and 3 years
how did they define cv event
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.
give percentages again in reach of a vascular event at 1 and 3 years
- 1 year 15% if CAD, and 20% if PAD; 3 year 20% cad and 40% pad.
if they ask what percent at 1 year and 3 years were on medication
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.
What were the limb rates in reach at 4 years (4 years is random bc the other endpoints were 1 and 3 years)
4 years - 18% revasc and 4 amp. this is on guideline directed rx.
How does this compare to your clinic profile
Hx of CAD, PAD, CVA or > 65/70 +HTN +HLD or DM –> all of them!
In reach WP had polyvacsular disease
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.
describe compass
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)
biggest improvement w compass
stroke rpevention almos tcut events in had 42%RRR RRR calculated using 1 -HR.
THM
there was a mortality benefit!!!!
I know what you are thinking why not just keep them on dapt after there MI?
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.
- Compositive was in favor. This shows pure mortality difference.
favorite slide
ALI table Cut rates of ALI in half as well as amp. that huge bc ALI careis a 25% mort.