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Core Curriculum

• Impact of vascular biology in treatment of cardiovascular disease Section IV: Antithrombotic interventions in acute coronary syndromes

The VBWG Core Curriculum 2002 slide lecture program, Impact of vascular biology in treatment of cardiovascular disease, covers basic science and clinical advances in vascular biology in a spectrum of disorders. The material is presented in four sections:

This is the 4th and final section of the Core Curriculum 2002. The slides and accompanying notes in this section encompass the epidemiology, pathophysiology, and management of the acute coronary syndromes. The issues that are addressed include:

  • The important role of antithrombotic therapy in patient management
  • Emerging differences within antithrombotic classes
  • New combinations of pharmacologic and mechanical reperfusion regimens



corerefs.pdf (0.0MB)corerefs.pdf (0.0MB)

S001.ppt

Download S001.ppt (2 slides - 0.3MB)

Slide 1 ACS: Common presentation of CAD

Section B: Science update

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Section B: Science update Overview of the coagulation cascade Antithrombotic therapies: Main sites of action Antithrombotic effects of LMWH Antiplatelet therapies in ACS Antithrombotic therapies in ACS: Anticoagulants

Section C: Clinical trial update: Oral antiplatelet therapy

Download S003.ppt (3 slides - 0.5MB)

Section C: Clinical trial update: Oral antiplatelet therapy CURE: Bleeding complications PCI-CURE: Reduction in CV death or MI with clopidogrel

Section D: Clinical trial update: GP IIb/IIIa inhibition

Download S004.ppt (17 slides - 2.8MB)

Section D: Clinical trial update: GP IIb/IIIa inhibition GUSTO IV-ACS: Neutral effect of abciximab IV GP IIb/IIIa inhibition: Treatment effects in 7 PCI trials TARGET: Protection from early acute ischemic events: Tirofiban vs abciximab in PCI TARGET: Treatment effects of tirofiban and IV abciximab in stable/unstable CAD TACTICS–TIMI 18: Evaluation of invasive and conservative strategies in UA/NSTEMI TACTICS–TIMI 18: Primary outcome (death, nonfatal MI, rehospitalization for ACS) TACTICS–TIMI 18: Greater benefit among high-risk subgroups ADMIRAL: IV GP IIb/IIIa inhibition in primary PCI for STEMI CADILLAC: Evaluation of stenting and PTCA ± IV GP IIb/IIIa inhibition CADILLAC: Treatment effects on primary outcome CADILLAC: Treatment effects on primary outcome by age and sex CADILLAC: Treatment effects on primary outcome GUSTO V: Evaluation of combined fibrinolytic and IV GP IIb/IIIa inhibition GUSTO V: Treatment effects on mortality GUSTO V: Bleeding complications and stroke at 30 days Increased mortality with oral GP IIb/IIIa inhibition

Section E: Clinical trial update: Heparins

Download S005.ppt (27 slides - 4.0MB)

Section E: Clinical trial update: Heparins Advantages of LMWH vs UFH Pharmacokinetics of LMWH in patients at time of angiography Clinical implications of predictable anticoagulant effect ESSENCE: Evaluation of LMWH and UFH in UA/NQMI ESSENCE: Primary outcome ESSENCE: Cumulative 30-day costs for all patients TIMI 11B: Evaluation of LMWH and UFH in UA/NQMI TIMI 11B: Primary outcome at 72 hours TIMI 11B: Primary outcome at 43 days TIMI 11B–ESSENCE meta-analysis: Treatment effect on death, MI TIMI 11B–ESSENCE meta-analysis: Treatment effect maintained long-term TIMI 11B–ESSENCE meta-analysis: Treatment effects in patients with/without PCI TIMI 11B–ESSENCE meta-analysis: Hemorrhagic events (acute phase) Trials of LMWH vs UFH in patients with UA/NSTEMI HART-II: Evaluation of combined fibrinolytic and UFH/LMWH HART-II: Infarct artery patency at 90 min Evaluation of combined fibrinolytic and UFH/LMWH in STEMI Treatment effects of fibrinolytic plus UFH/LMWH ASSENT-3: Evaluation of combined fibrinolytic, GP IIb/IIIa inhibition, and UFH/LMWH ASSENT-3: Primary efficacy outcome ASSENT-3: Primary efficacy plus safety outcome ASSENT-3: Stroke and noncerebral hemorrhagic complications ENTIRE–TIMI 23: Evaluation of combined fibrinolytic, GP IIb/IIIa inhibition, and UFH/LMWH ENTIRE–TIMI 23: Treatment effects on primary efficacy outcome ENTIRE–TIMI 23: Treatment effects on primary safety outcome ENTIRE–TIMI 23: Treatment effects on death/MI

Section F: Clinical guidelines

Download S006.ppt (9 slides - 1.5MB)

Section F: Clinical guidelines TIMI risk score: Suggested method for estimating early risk ACC/AHA guidelines for UA/NSTEMI ACC/AHA guidelines for UA/NSTEMI: IV GP IIb/IIIa inhibition ACC/AHA guidelines for UA/NSTEMI: IV GP IIb/IIIa inhibition ACC/AHA guidelines for UA/NSTEMI: IV GP IIb/IIIa inhibition ACC/AHA guidelines for UA/NSTEMI ACC/AHA guidelines for UA/NSTEMI: Heparins ACC/AHA guidelines for UA/NSTEMI

Published by Medical Education Consultants, Inc. (MEDCON), on behalf of the University of Florida College of Medicine.

The editorial content of this program does not necessarily reflect the views or recommendations of the University of Florida College of Medicine, AstraZeneca, Aventis Pharmaceuticals, Monarch Pharmaceuticals, Pfizer Inc, or Wyeth Pharmaceuticals.

This program was prepared and produced by Medical Education Consultants Inc, Westport, Connecticut, on behalf of the University of Florida College of Medicine through an unrestricted educational grant provided by AstraZeneca, Aventis Pharmaceuticals, Monarch Pharmaceuticals, Pfizer Inc, and Wyeth Pharmaceuticals.

©2002 Medical Education Consultants, Inc. (MEDCON). All rights reserved.

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