Switching from Plavix to Effient? Any need or data?

FROM CARDIOSOURCE: http://tinyurl.com/cy7wpaf

Journal Scan Summary

Title:	A Randomized Trial of Prasugrel Versus Clopidogrel
Date Posted:	April 18, 2012
Authors:	Trenk D, Stone G, Gawaz M, et al.
Citation:	J Am Coll Cardiol 2012;Apr 18:[Epub ahead of print].

Study Question:

What is the safety and efficacy of prasugrel as compared with clopidogrel in patients with high on-treatment platelet reactivity (HTPR) after elective percutaneous coronary intervention (PCI)?

Methods:

The authors enrolled patients who had HTPR on clopidogrel after undergoing PCI with drug-eluting stents for stable coronary artery disease. HTPR was defined as >208 P2Y₁₂ reaction units [PRU] by the VerifyNow test. A total of 423 patients were randomly assigned to either prasugrel 10 mg daily or clopidogrel 75 mg daily. Platelet reactivity of the patients on the study drug was reassessed at 3 and 6 months. The study was stopped prematurely for futility.

Results:

Among the 212 patients assigned to prasugrel, PRU decreased from a median of 245 to 80 at 3 months, whereas in 211 patients assigned to clopidogrel, PRU decreased from 249 to 241 (p < 0.001 vs. prasugrel). There was no difference in the primary efficacy endpoint of cardiac death or myocardial infarction at 6 months (none on prasugrel vs. one on clopidogrel). The primary safety endpoint of non–coronary artery bypass graft Thrombolysis in Myocardial Infarction major bleeding at 6 months occurred in three patients (1.4%) on prasugrel versus one (0.5%) on clopidogrel.

Conclusions:

The authors concluded that switching from clopidogrel to prasugrel in patients with HTPR was associated with effective platelet inhibition. Despite the enhanced platelet inhibition, there was no difference in ischemic events, which were low in both arms.

Perspective:

This study failed to demonstrate a clinical benefit of better platelet inhibition with prasugrel in patients with HTPR after elective PCI. Combined with the results of the GRAVITAS trial, these findings question the utility of using platelet function assays to guide antiplatelet therapy after elective PCI. Furthermore, the ischemic event rates in this population were very low in patients who were treated with clopidogrel, and it should remain the thienopyridine of choice in patients undergoing elective PCI.

Author(s):

Hitinder S. Gurm, M.B.B.S., F.A.C.C. (Disclosure)

Topic(s):

Interventional Cardiology, General Cardiolog

Only 3 Months of Aspirin and Plavix after a Drug Eluting Stent?

Nice article in Cardiology News: http://tinyurl.com/7xxmga3

Major Finding: Patients assigned to 3 months of dual antiplatelet therapy following implantation of a zotarolimus-eluting stent had a 1-year combined adverse event rate of 4.7%, identical to that in recipients of other drug-eluting stents plus the standard 12 months of dual antiplatelet therapy.

Data Source: An open-label, randomized trial including 2,117 patients who received a zotarolimus-eluting Endeavor stent and 3 months of dual antiplatelet therapy, or a different drug-eluting stent and the standard 12 months of dual antiplatelet therapy.

Disclosures: The study was sponsored by the South Korean Ministry of Health and Welfare, the Cardiovascular Research Center of Seoul, and Medtronic.

Weight Loss

Everyone has struggled with the question: What is the best way to lose weight? There is no magically diet or pills that can bring your weight down safely. The basics: It is all about calories: take how many calories you consume in a day minus the amount of calories you burn. If you burn more calories than you take in, you will lose weight.

A great article from LIVESTRONG.COM

http://www.livestrong.com/article/460819-recommended-caloric-intake-based-on-weight/

Maintaining your weight can be a challenge as you age. The simplest way to maintain a healthy weight is to know how many calories you need to eat, and then consume roughly that amount each day. If you need to lose or gain weight, you can modify this number to meet your needs.

Basics: Multiply your current weight by 13 to if you are male and 10 if you are female. This is the base number of calories you need to maintain your current weight.Lose Belly Fat Naturally 3 sneaky hormones that are making you fat & how to stop them now.

Activity Level: If you are active, you need more calories than if you are sedentary. If you perform cardiovascular exercise several times a week or have a physical job, add two to the number by which you multiply your weight. For example, if you are a man who works out several times a week, multiply your weight by 15. The resulting number is the amount of calories you should eat each day to maintain your weight.

Age: As you age, you will probably find that you need fewer calories. Make small adjustments in the amount you eat now and you can eliminate the unpleasant surprise of an extra 10 or more pounds next year. The easiest way to know if you need to adjust is to maintain a food diary and weigh yourself regularly. By doing this, you will catch weight gain early and know how many calories you consume, which allows you to cut back and lose the weight painlessly.

Weight Gain or Loss: Once you know how many calories you should consume each day, you can adjust the number to meet your goals. If you are happy with your weight, make this your target number. If you want to lose weight, lower the amount of calories you consume by 300 per day. In addition, add enough physical activity to burn another 300 calories each day. You can burn approximately 300 calories by walking briskly for an hour or jogging for 30 minutes. If you want to gain weight, increase the number of calories you eat by 500 or more daily and add strength training to your workout for healthy weight gain.