SPEAKERS: Jennifer Chen, MD; John Paul Farala, MD and Lisa Wang, MD

PLANNER: Reena Bhargava, MD

LEARNING OBJECTIVES: 

1. To critically read a journal article and draw conclusions applicable to clinical practice regarding specific clinical problems by using a systematic and standardized approach

2. Utilizing the information obtained from the journal articles, the physician will demonstrate an analytical and investigative approach to patient care  

 3 articles will be reviewed that can bring about some practice changes and also reinforce our current practice. 

1. Ticagrelor as a monotherapy after PCI is emerging as a treatment strategy.  This article describes a double blinded RCT that compares monotherapy with Ticagrelor to Ticagrelor with aspirin in patients with recent PCI who either have high bleeding risk or high risk for ischemic event. 

2. Ticagrelor is increasingly used for antiplatelet agent, but comes with significant bleeding risk like any other antiplatelet agent.  This article will describe initial experience with an antibody as potential reversal agent of antiplatelet effect from Ticagrelor.

3. Aspirin is commonly used in stable CAD to decrease risk for cardiovascular events.  This article compares aspirin to aspirin plus Ticagrelor in patients with stable CAD and DM to determine if there is decrease in cardiovascular events, or increased risk of bleed. 

Citations for above articles:

1.  Mehran, R et al. Ticagrelor with or without Aspirin in High-Risk Patients after PCI. N Engl J Med 2019; 381:2032-2042

2.  Bhatt, D et al. Antibody-Based Ticagrelor Reversal Agent in Healthy Volunteers. N Engl J Med 2019; 380:1825-1833 

3.  Stegg, PG et al. Ticagrelor in Patients with Stable Coronary Disease and Diabetes. N Engl J Med 2019; 381:1309-1320

             CREDITS & ACCREDITATION
            1 AMA PRA Category 1 Credit(s)™

FACULTY & DISCLOSURE:
The presenter & planner for this activity have disclosed that they have no relevant relationships with commercial or industry organizations (Commercial Interest). The CME Department has reviewed their disclosure information for the planner(s) and faculty for this activity and they do not have relationships that present a relevant conflict of interest. Kaiser Permanente does not endorse any brand name products.

Kaiser Santa Clara is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide continuing medical education for physicians. The Kaiser Santa Clara designates this Live Activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.