Disease State Platelet Presentation

Volume 2

Presented By:

Name

An ACS Case Study: Mr. Jacobs

Case Study: Pre-Angiogram

• Lesion in the Lesion in the mid LADmid LAD

• Proceeded with Proceeded with PCIPCI

• PCI SuccessfulPCI Successful

• Post PCI MedsPost PCI Meds• ACE inhibitorACE inhibitor

• Beta-blockerBeta-blocker

• StatinStatin

• Dual antiplatelet Dual antiplatelet therapytherapy

Case Study: Post-Angiogram

Post PCI Arterial Environment

Arterial wall damage and plaque disruption

Exposure of thrombotic substrates

SMCSMC

Stent Thrombosis

Adhesion Activation Aggregation

Dual Antiplatelet Therapy in the PCI Patient

Manages the prothrombotic environmentManages the prothrombotic environment

Reduces risk of MI and deathReduces risk of MI and death

Platelet Platelet MonolayerMonolayer

The Progression of Atherosclerotic Disease Continues

Plaque formation is likely to continue in this ACS patientPlaque formation is likely to continue in this ACS patient

Spontaneous Rupture and Thrombus Formation

Premature Discontinuation of Dual Antiplatelet Therapy

AtherothrombosisAtherothrombosis

Premature Discontinuation of Dual Antiplatelet Therapy

Increased risk of MI and deathIncreased risk of MI and death

Minimizing the Risk of Atherothrombotic Events in the ACS patient

• PPercutaneous ercutaneous CCoronary oronary IInterventionntervention

• Long-term medical managementLong-term medical management

•Dual antiplatelet therapyDual antiplatelet therapy

• Lifestyle changesLifestyle changes

Smith SC Jr, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). American Heart Association Website. Available at: http://www.americanheart.org.

Dual Antiplatelet Therapy Continued

in this ACS Patient

Platelet monolayer is formed and activation is better managed

Managing the Risks: A Summary

Long term dual antiplatelet therapy Long term dual antiplatelet therapy helps prevent atherothrombosis caused byhelps prevent atherothrombosis caused by

PCI and spontaneous plaque rupturePCI and spontaneous plaque rupture

ACC/AHA/SCAI 2005 Guidelines for PCI

Current guidelines recommend dual Current guidelines recommend dual antiplatelet therapy be given ideally up to antiplatelet therapy be given ideally up to

12 months in patients who have undergone 12 months in patients who have undergone PCI and who are not at a high risk of bleeding.PCI and who are not at a high risk of bleeding.

  

Smith SC Jr, Feldman TE, Hirschfeld JW Jr, Jacobs AK, Kern MJ, King SB III, Morrison DA, O’Neill WW, Schaff HV, Whitlow PL, Williams DO. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). American Heart Association Website. Available at: http://www.americanheart.org.