Hon. James McGing (ret.)’s Post

In patients undergoing PCI, ticagrelor but not clopidogrel monotherapy was non-inferior to DAPT for the prevention of ischemic events and superior for NACE. Major bleeding was similarly reduced with ticagrelor and clopidogrel monotherapy vs DAPT. https://ja.ma/3Tp0HUg

A very important meta analysis regarding patients with A.Fib and stable CAD and the ideal anti-thrombotic therapy. From this meta-analysis. OAC monotherapy led to a significant relative risk reduction for major bleeding with similar rates of ischemic events and mortality compared to dual antithrombotic therapy in patients with AF and stable CAD. This is a paradigm change for patients with A fib and stable CAD. We can now consider the use of OAC monotherapy without use of antiplatele therapy as a strategy with lower risk of bleeding without compromising on risk of ischemic events and mortality.

OAC alone is superior on bleeding with similar ischemic event rates in patients with AFib and CAD: new meta-analysis of 3 trials. This appears to be the new optimal strategy.

Selective thrombosis is very effective

The pathophysiology of heart failure (HF) is related to the overactivation of the mineralocorticoid receptor (MR), leading to fluid retention and adverse myocardial remodeling. While mineralocorticoid receptor antagonists (MRAs) are recommended for the treatment of HF with reduced ejection fraction (HFrEF), they remain underused due to adverse effects like hyperkalemia; and their efficacy is controversial in HF with mildly reduced ejection fraction (HFmrEF) and HF with preserved ejection fraction (HFpEF). Recent trials in people with diabetes and kidney disease have supported the use of nonsteroidal MRAs in reducing HF related morbidity and mortality and have less side effects than their steroidal counterparts. The efficacy and safety of non-steroidal MRAs have not been tested in HF and are currently being evaluated in additional clinical trials. This review comprehensively examines the current data regarding MRAs for HF and the future direction of nonsteroidal MRA research while exploring the causes of MRA underutilization. https://lnkd.in/gswNuyXC

Rapid PCR Tests for Pneumonia in the ED Speed Up Targeted Treatment For people with suspected community-acquired pneumonia (CAP) in the emergency department (ED), routine polymerase chain reaction (PCR) testing on lower respiratory tract samples led to faster and more targeted treatment, according to a randomized, single-center trial. People who got rapid PCR tests were more likely to receive pathogen-directed treatment in the first 48 hours post-randomization compared with those receiving standard of care. And in those receiving a pathogen-directed agent in that timeframe, the intervention group received treatment significantly sooner; as reported by authors of the University of Bergen in Norway. "Routinely deployed rapid syndromic testing could complement or replace targeted components of the standard laboratory-based diagnostic repertoire for patients who are admitted to the hospital with an acute respiratory illness," the authors concluded from their 374-person study, which had been stopped early for efficacy. Despite the limited evidence so far, a PCR panel for CAP is believed by some to improve pathogen detection, reduce unnecessary antibiotic use, shorten hospital length of stay, and potentially facilitate pathogen-directed treatment. Current culture-based methods are labor intensive and in most cases fail to detect a pathogen for targeted treatment. Yet expert at the University of Southern California in Los Angeles, warned that "despite assertions to the contrary, this is not a replacement for culture. Culture is essential to assess the quality of the specimen, and critically, for performing antimicrobial susceptibility testing.” "Future studies should examine the effect of comprehensive rapid syndromic testing on clinical outcomes, the cost-effectiveness of this diagnostic tool, and the development of implementation strategies that facilitate the integration of rapid syndromic testing into routine clinical practice," the group at the University of Bergen urged. https://lnkd.in/ddjyckkd

In this months Prescriber Insights, We answer questions about the role of DAPT after a minor stroke. New data will raise questions about optimal use of short-term dual antiplatelet therapy (DAPT) after an ischemic stroke or TIA. We know that short-term DAPT...such as aspirin plus clopidogrel for 21 days...reduces recurrent stroke risk compared to aspirin alone. Read our article now to learn more.

Elevated plasma fibrinogen levels in multiple sclerosis patients during relapse Miranda Acuña J, Hidalgo de la Cruz M, Ros AL, Tapia SP, Martínez Ginés ML, de Andrés Frutos CD. Elevated plasma fibrinogen levels in multiple sclerosis patients during relapse. Mult Scler Relat Disord. 2017 Nov;18:157-160. doi: 10.1016/j.msard.2017.09.033. Epub 2017 Sep 30. PMID: 29141800. https://lnkd.in/ek8MhES2 If measurements of 25(OH)D3 and/or calcitriol reveal deficiency, supplement to bring fibrinogen to 2.5 grams/liter. Otherwise, consider Ivermectin to reduce fibrinogen from elevated levels down to 2.5 grams/liter. Feedback from those I dealt with during COVID-19 with MS reveal a stark improvement with supplementation to correct D3 deficiency. #MS #hyperfibrinogenemia #supplement D3 #lab tests when feasible

Myocardial infarction (MI) - part 1 MI is defined pathologically as myocardial cell death due to prolonged ischemia. According to 2018 AHAIASA Journal: The term myocardial injury should be used when there is evidence of elevated cardiac troponin values (cTn) with at least 1 value above the 99th percentile upper reference limit (URL). Troponin is a protein found in the muscles of the heart and other parts of the body. When the heart muscle is damaged, troponin is released into the bloodstream, increasing the amount of troponin in the blood. The criteria to diagnose Acute Myocardial Infarction (AMI) are: - Symptoms of myocardial ischemia (hard and deep pressure pain in the chest, which can or can not be irradiated to left neck/shoulder or arm). - New ischemic (oxygenation insufficiency) ECG changes - Development of pathological Q waves (representation of first part of electrical depolarization of ventricles). - Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology (origin). - Identification of a coronary thrombus by angiography or autopsy.

https://lnkd.in/djjHp-KQ Sodium Zirconium Cyclosilicate - The trial shows that SZC can safely enable the use of mineralocorticoid receptor antagonists (MRAs) in heart failure patients with reduced ejection fraction (HFrEF) at risk of hyperkalemia.