Optimizing Antithrombotic Therapy in Patients With Atrial Fibrillation Who Have an Acute Coronary Syndrome or Have Undergone PCI: New Data, New Directions
Release Date: December 18, 2019
Last Reviewed: December 17, 2019
Expiration Date: December 18, 2020
Time to Complete Activity: 1.5 hours
Last Reviewed: December 17, 2019
Expiration Date: December 18, 2020
Time to Complete Activity: 1.5 hours
*This activity expired for credit on December 18, 2020 and is no longer available for credit
This activity is jointly provided by Paradigm Medical Communications, LLC and Educational Review Systems, Inc.
Faculty
Renato D. Lopes, MD, MHS, PhD (Chair)
Professor of Medicine
Division of Cardiology
Duke University Medical Center
Duke Clinical Research Institute
Durham, NC
Renato D. Lopes, MD, MHS, PhD (Chair)
Professor of Medicine
Division of Cardiology
Duke University Medical Center
Duke Clinical Research Institute
Durham, NC
Deepak L. Bhatt, MD, MPH
Professor of Medicine
Harvard Medical School
Executive Director of Interventional Cardiovascular Programs
Division of Cardiovascular Medicine
Brigham and Women’s Hospital
Boston, MA
Professor of Medicine
Harvard Medical School
Executive Director of Interventional Cardiovascular Programs
Division of Cardiovascular Medicine
Brigham and Women’s Hospital
Boston, MA
John Fanikos, RPh, MBA
Executive Director of Pharmacy Services
Brigham and Women’s Hospital
Adjunct Professor of Clinical Pharmacy
Massachusetts College of Pharmacy and Health Sciences
Boston, MA
Executive Director of Pharmacy Services
Brigham and Women’s Hospital
Adjunct Professor of Clinical Pharmacy
Massachusetts College of Pharmacy and Health Sciences
Boston, MA
Target Audience
This activity has been designed to address the educational needs of general cardiologists, interventional cardiologists, internists, and pharmacists. It may also benefit other healthcare providers (HCPs) who are involved in antithrombotic decisions for patients with atrial fibrillation (AF) who have an acute coronary syndrome (ACS) or have undergone percutaneous coronary intervention (PCI).
This activity has been designed to address the educational needs of general cardiologists, interventional cardiologists, internists, and pharmacists. It may also benefit other healthcare providers (HCPs) who are involved in antithrombotic decisions for patients with atrial fibrillation (AF) who have an acute coronary syndrome (ACS) or have undergone percutaneous coronary intervention (PCI).
Statement of Need
Optimal antithrombotic management of patients with AF who have an ACS or have undergone PCI has long been a gray area. In the absence of evidence, clinicians have typically managed such patients with a course of triple therapy—dual antiplatelet therapy (P2Y12 inhibitor + aspirin) plus a vitamin K antagonist (VKA)—to protect against ischemic/thromboembolic events. However, this comes at the cost of higher bleeding risk. Recent data demonstrating significantly safer outcomes with double therapy (P2Y12 inhibitor + non-VKA oral anticoagulant [NOAC]) challenge this long-held standard of care. To upend suboptimal practices, clinicians would benefit from expert-led, case-based education to become familiar with the robust data that herald a new, evidence-based standard of care. Expert guidance on the selection of an oral anticoagulant (OAC) and a P2Y12 inhibitor and the appropriate duration of antiplatelet therapy would help clinicians improve outcomes in the heterogeneous patients with AF who have an ACS or have undergone PCI whom they encounter every day.
Optimal antithrombotic management of patients with AF who have an ACS or have undergone PCI has long been a gray area. In the absence of evidence, clinicians have typically managed such patients with a course of triple therapy—dual antiplatelet therapy (P2Y12 inhibitor + aspirin) plus a vitamin K antagonist (VKA)—to protect against ischemic/thromboembolic events. However, this comes at the cost of higher bleeding risk. Recent data demonstrating significantly safer outcomes with double therapy (P2Y12 inhibitor + non-VKA oral anticoagulant [NOAC]) challenge this long-held standard of care. To upend suboptimal practices, clinicians would benefit from expert-led, case-based education to become familiar with the robust data that herald a new, evidence-based standard of care. Expert guidance on the selection of an oral anticoagulant (OAC) and a P2Y12 inhibitor and the appropriate duration of antiplatelet therapy would help clinicians improve outcomes in the heterogeneous patients with AF who have an ACS or have undergone PCI whom they encounter every day.
Learning Objectives
Upon proper completion of this activity, participants should be better able to:
• Interpret key clinical findings from recent trials related to antithrombotic management of patients with AF who have an ACS or have undergone PCI
• Choose optimal antithrombotic treatment for patients with AF who have an ACS or have undergone PCI based on the latest evidence, and with consideration of stroke and bleeding risks
• Individualize the duration of antithrombotic therapy in patients with AF who have an ACS or have undergone PCI based on patient risk factors
Upon proper completion of this activity, participants should be better able to:
• Interpret key clinical findings from recent trials related to antithrombotic management of patients with AF who have an ACS or have undergone PCI
• Choose optimal antithrombotic treatment for patients with AF who have an ACS or have undergone PCI based on the latest evidence, and with consideration of stroke and bleeding risks
• Individualize the duration of antithrombotic therapy in patients with AF who have an ACS or have undergone PCI based on patient risk factors
Table of Contents
• Introduction
• Double Versus Triple Antithrombotic Therapy for Patients With AF Who Have an ACS or Have Undergone PCI: What Does the Evidence Say?
• Case Studies
• Introduction
• Double Versus Triple Antithrombotic Therapy for Patients With AF Who Have an ACS or Have Undergone PCI: What Does the Evidence Say?
• Case Studies
o Management of Patients With AF Who Have an ACS or Have Undergone PCI: Evidence in Action
Physician Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Paradigm Medical Communications, LLC and Educational Review Systems, Inc. Paradigm Medical Communications, LLC is accredited by the ACCME to provide continuing medical education for physicians.
Physician Credit Designation Statement
Paradigm Medical Communications, LLC designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Paradigm Medical Communications, LLC designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Pharmacist Accreditation and Designation Statement
Educational Review Systems is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is approved for 1.5 hours (0.15 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. (Universal Activity Number – 0761-9999-19-234-H01-P)
Educational Review Systems is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is approved for 1.5 hours (0.15 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. (Universal Activity Number – 0761-9999-19-234-H01-P)This is a knowledge-based activity.
This activity is jointly provided by Educational Review Systems, Inc and Paradigm Medical Communications, LLC.
PA Continuing Education
PAs may claim a maximum of 1.5 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.
PAs may claim a maximum of 1.5 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.
Nurse Practitioner Continuing Education
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines.
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines.
Disclosure of Commercial Support
Supported by educational grants from the Bristol-Myers Squibb and Pfizer Alliance; and AstraZeneca Pharmaceuticals LP.
Supported by educational grants from the Bristol-Myers Squibb and Pfizer Alliance; and AstraZeneca Pharmaceuticals LP.
Instructions for Participation
To receive credit, you should:
• Follow instructions to register or log in with your professional information and complete the preactivity assessment
• View the online activity in its entirety
• Complete and submit the online posttest and evaluation
A certificate of participation/statement of participation will be available for download/printing immediately following your successful completion of the posttest and evaluation.
To receive credit, you should:
• Follow instructions to register or log in with your professional information and complete the preactivity assessment
• View the online activity in its entirety
• Complete and submit the online posttest and evaluation
A certificate of participation/statement of participation will be available for download/printing immediately following your successful completion of the posttest and evaluation.
Please note: to claim CPE credit, please make sure you include your date of birth and NABP number. All credit information will be uploaded into CPE Monitor within 30 days.
For questions regarding CME/CPE credit, contact the Paradigm CME Department at (845) 398-5949.
There is no fee required for participation in this activity.
For questions regarding CME/CPE credit, contact the Paradigm CME Department at (845) 398-5949.
There is no fee required for participation in this activity.
Hardware/Software Requirements
This certified CME/CPE activity is designed using HTML5 video. As you navigate the video using the supplied controls, the slides will sync to the speaker.
Supported Browsers:
For Desktops (Windows/Mac)
Microsoft Edge 40 or higher, Firefox 28 or higher, Safari 5.1 or higher, Google Chrome 31 or higher, Opera 21 or higher
This certified CME/CPE activity is designed using HTML5 video. As you navigate the video using the supplied controls, the slides will sync to the speaker.
Supported Browsers:
For Desktops (Windows/Mac)
Microsoft Edge 40 or higher, Firefox 28 or higher, Safari 5.1 or higher, Google Chrome 31 or higher, Opera 21 or higher
For Tablets (iPad/Android/Surface)
iOS Safari 4 or higher, Android 2.3 or higher, IE Mobile 10 or higher
iOS Safari 4 or higher, Android 2.3 or higher, IE Mobile 10 or higher
Technical Support: If you have any technical problems or playback issues, email us at contactus@paradigmmc.com.
Disclosures
In accordance with ACCME and ACPE requirements on disclosure, faculty and contributors are asked to disclose any relationships with commercial interests associated with the area of medicine featured in the activity. These relationships are described below.
In accordance with ACCME and ACPE requirements on disclosure, faculty and contributors are asked to disclose any relationships with commercial interests associated with the area of medicine featured in the activity. These relationships are described below.
Faculty
Renato D. Lopes, MD, MHS, PhD
Grant/Research Support: Bristol-Myers Squibb Company; GlaxoSmithKline; Medtronic; Pfizer Inc; sanofi-aventis U.S. LLC
Retained Consultant: Bayer HealthCare; Boehringer Ingelheim Pharmaceuticals, Inc; Bristol-Myers Squibb Company; Daiichi Sankyo, Inc; GlaxoSmithKline; Medtronic; Merck & Co., Inc; Pfizer Inc; Portola Pharmaceuticals, Inc.; sanofi-aventis U.S. LLC
Deepak L. Bhatt, MD, MPH
Grant/Research Support: Abbott Laboratories; Afimmune Limited; Amarin Corporation; Amgen Inc; AstraZeneca; Bayer HealthCare; Boehringer Ingelheim Pharmaceuticals, Inc; Bristol-Myers Squibb Company; Chiesi USA, Inc.; CSL Behring; Eisai, Inc; Ethicon, Inc; Ferring Pharmaceuticals; Forest Laboratories, Inc; Idorsia Pharmaceuticals Ltd; Ironwood Pharmaceuticals, Inc; Ischemix; Lilly; Medtronic; PhaseBio Pharmaceuticals, Inc.; Pfizer Inc; Regeneron Pharmaceuticals, Inc; Roche; sanofi-aventis U.S. LLC; Synaptic; The Medicines Company
Renato D. Lopes, MD, MHS, PhD
Grant/Research Support: Bristol-Myers Squibb Company; GlaxoSmithKline; Medtronic; Pfizer Inc; sanofi-aventis U.S. LLC
Retained Consultant: Bayer HealthCare; Boehringer Ingelheim Pharmaceuticals, Inc; Bristol-Myers Squibb Company; Daiichi Sankyo, Inc; GlaxoSmithKline; Medtronic; Merck & Co., Inc; Pfizer Inc; Portola Pharmaceuticals, Inc.; sanofi-aventis U.S. LLC
Deepak L. Bhatt, MD, MPH
Grant/Research Support: Abbott Laboratories; Afimmune Limited; Amarin Corporation; Amgen Inc; AstraZeneca; Bayer HealthCare; Boehringer Ingelheim Pharmaceuticals, Inc; Bristol-Myers Squibb Company; Chiesi USA, Inc.; CSL Behring; Eisai, Inc; Ethicon, Inc; Ferring Pharmaceuticals; Forest Laboratories, Inc; Idorsia Pharmaceuticals Ltd; Ironwood Pharmaceuticals, Inc; Ischemix; Lilly; Medtronic; PhaseBio Pharmaceuticals, Inc.; Pfizer Inc; Regeneron Pharmaceuticals, Inc; Roche; sanofi-aventis U.S. LLC; Synaptic; The Medicines Company
John Fanikos, RPh, MBA
No financial relationships to disclose.
No financial relationships to disclose.
Paradigm Medical Communications, LLC staff members have no financial relationships to disclose.
Educational Review Systems, Inc staff members have no financial relationships to disclose.
Independent peer reviewer has no financial relationships to disclose.
Resolution of Conflict of Interest
Paradigm Medical Communications, LLC and Educational Review Systems, Inc have implemented a system to resolve conflicts of interest for each CME/CPE activity to help ensure content objectivity, independence, fair balance, and that the content is aligned with the interest of the public. Conflicts, if any, are resolved through one or more processes. All CME/CPE content in this activity was independently reviewed to ensure that it is free of commercial bias, scientifically rigorous, aligned with the public interest, and compliant with all regulatory guidance, ACPE Guidelines, and ACCME’s Standards for Commercial Support of Continuing Medical Education.
Paradigm Medical Communications, LLC and Educational Review Systems, Inc have implemented a system to resolve conflicts of interest for each CME/CPE activity to help ensure content objectivity, independence, fair balance, and that the content is aligned with the interest of the public. Conflicts, if any, are resolved through one or more processes. All CME/CPE content in this activity was independently reviewed to ensure that it is free of commercial bias, scientifically rigorous, aligned with the public interest, and compliant with all regulatory guidance, ACPE Guidelines, and ACCME’s Standards for Commercial Support of Continuing Medical Education.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA.
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA.
Disclaimer
This CME/CPE activity represents the views and opinions of the individual faculty, and does not constitute the opinion or endorsement of, or promotion by, Paradigm Medical Communications, LLC or Educational Review Systems, Inc. Reasonable efforts have been taken to present educational subject matter in a balanced, unbiased fashion, and in compliance with regulatory requirements. However, each activity participant must always use his or her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses.
This CME/CPE activity represents the views and opinions of the individual faculty, and does not constitute the opinion or endorsement of, or promotion by, Paradigm Medical Communications, LLC or Educational Review Systems, Inc. Reasonable efforts have been taken to present educational subject matter in a balanced, unbiased fashion, and in compliance with regulatory requirements. However, each activity participant must always use his or her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses.
If included, signed statements of informed consent granting permission for use have been obtained for all photographs and videos in which an individual can be identified.
As accredited providers, Paradigm Medical Communications, LLC and Educational Review Systems, Inc activities must include a balanced view of therapeutic options. Use of generic names contributes to this impartiality. The use of trade names should not be viewed as an endorsement of specific products by Paradigm Medical Communications, LLC or Educational Review Systems, Inc.
Terms of Use and Privacy Policy
Disclaimer
The materials provided for this activity are for informational purposes only, and should not be used for diagnosis or treatment of a health problem without consulting a licensed medical professional. This CME/CPE activity represents the views and opinions of the individual faculty, and does not constitute the opinion or endorsement of, or promotion by, Paradigm Medical Communications, LLC or Educational Review Systems, Inc. References to any entity, product, service, or source of information on this website should not be considered an endorsement, either direct or implied, by Paradigm Medical Communications, LLC or Educational Review Systems, Inc. Paradigm Medical Communications, LLC and Educational Review Systems, Inc accept no liability for the content referenced in this activity.
Disclaimer
The materials provided for this activity are for informational purposes only, and should not be used for diagnosis or treatment of a health problem without consulting a licensed medical professional. This CME/CPE activity represents the views and opinions of the individual faculty, and does not constitute the opinion or endorsement of, or promotion by, Paradigm Medical Communications, LLC or Educational Review Systems, Inc. References to any entity, product, service, or source of information on this website should not be considered an endorsement, either direct or implied, by Paradigm Medical Communications, LLC or Educational Review Systems, Inc. Paradigm Medical Communications, LLC and Educational Review Systems, Inc accept no liability for the content referenced in this activity.
Privacy policy
Paradigm Medical Communications, LLC and Educational Review Systems, Inc or hosted contracted partner is committed to protecting the privacy of those who participate in the activities located at www.paradigmmc.com (herein referred to as “website"). The information below describes the security of the website for safeguarding personal information and the rationale for collection and use of personal information.
Security/safeguarding personal information
This website has physical and procedural safeguards in place to prevent unauthorized access to personal information used to access this website.
Paradigm Medical Communications, LLC and Educational Review Systems, Inc or hosted contracted partner is committed to protecting the privacy of those who participate in the activities located at www.paradigmmc.com (herein referred to as “website"). The information below describes the security of the website for safeguarding personal information and the rationale for collection and use of personal information.
Security/safeguarding personal information
This website has physical and procedural safeguards in place to prevent unauthorized access to personal information used to access this website.
Collection and use of your personal information
The submission of certain personally identifiable information is necessary to award and track the credits participants may earn after completing the program. Required items include first name, last name, degree, and email address. These items are necessary. Participants are also required to complete an evaluation of the CME/CPE activity. All evaluative information submitted is collected and retained, and used by Paradigm Medical Communications, LLC and Educational Review Systems, Inc to continuously improve the learning experience.
The submission of certain personally identifiable information is necessary to award and track the credits participants may earn after completing the program. Required items include first name, last name, degree, and email address. These items are necessary. Participants are also required to complete an evaluation of the CME/CPE activity. All evaluative information submitted is collected and retained, and used by Paradigm Medical Communications, LLC and Educational Review Systems, Inc to continuously improve the learning experience.
Paradigm Medical Communications, LLC and Educational Review Systems, Inc do not transfer, sell, or share personal information with outside parties. Paradigm Medical Communications, LLC and Educational Review Systems, Inc will not otherwise disclose personal information unless required to in a legal process. Paradigm Medical Communications, LLC and Educational Review Systems, Inc staff members review individual test results to the extent necessary to record and track participants’ credits.
Contact Us
If you have any questions or comments, please email us at contactus@paradigmmc.com.
Contact Us
If you have any questions or comments, please email us at contactus@paradigmmc.com.
© 2019 Paradigm Medical Communications, LLC, except where noted. Content may not be reproduced in whole or part without the express written permission of Paradigm Medical Communications, LLC.