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| __NOTOC__
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| {{CMG}}; {{AE}}{{DN}}
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| ==Overview==
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| Dual antiplatelet therapy (or DAPT) refers to the combination of [[aspirin]] and a P2Y12 receptor antagonist. DAPT is approved for [[SIHD]] and interventions for [[ACS]], such as stent placement following [[PCI]] or [[CABG]]. The duration of treatment with DAPT for each of these categories differs and guidelines for treatment have been updated in the ''2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease''. Much of the studies done on DAPT compared the use of different types of P2Y12 receptor antagonists, the dosage of drugs, as well as the duration of treatment. The current consensus is that the use of DAPT is associated with decreased risk of [[stent thrombosis]], [[MI]] and [[stroke]]. However, the benefits of treatment should be weighed against the increased risk of major bleeding in certain patient populations.
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| ==Types and Dosage of Drugs==
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| ===Aspirin===
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| [[Aspirin]] 81 mg once daily (range 75-100 mg) is used in all patients with [[SIHD]], stent placement following [[PCI]] or [[CABG]]. The use of [[aspirin]] should be continued indefinitely.
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| ===P2Y12 Inhibitors===
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| There are several P2Y12 inhibitors currently on the market and they are given in the following doses:
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| *[[Clopidogrel]]: 75 mg once daily
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| *[[Ticagrelor]]: 90 mg once daily
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| *[[Prasugrel]]: 10 mg once daily
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| The drug of choice and duration of treatment depends on the medical condition and current recommendations.
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| ==Recommendations==
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| The 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease includes recommendations for [[ACS]] treated with medical therapy and/or [[PCI]], [[ACS]] treated with [[CABG]], as well as [[stable ischemic heart disease]]:
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| *[[Unstable angina/NSTEMI Antiplatelet therapy recommendations#2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease (Updating the 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes (DO NOT EDIT))|Unstable Angina/ NSTEMI Treated with Medical Therapy Alone]]
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| *[[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease|STEMI Treated with Medical Therapy Alone]]
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| *[[Pharmacotherapy to Support PCI#2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease|Following PCI]]
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| *[[Unstable angina / non ST elevation myocardial infarction recommendations for CABG#2016 ACC/AHA guideline focused update on duration of antiplatelet therapy in patients with coronary artery disease|CABG for NSTEMI]]
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| *[[ST elevation myocardial infarction coronary artery bypass grafting#2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease|CABG for STEMI]]
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| *[[Chronic stable angina revascularization adjunctive pharmacotherapy for percutaneous coronary intervention#2016 ACC/AHA Guideline focused update on duration of dual antiplatelet therapy (DAPT) in Patients with coronary artery disease|Stable Ischemic Heart Disease]]
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| ==The DAPT score==
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| The DAPT score is a risk score derived from the ''DAPT Trial''. It has been designed as a helpful tool for the continuation of dual antiplatelet therapy following [[PCI]] and the insertion of a drug-eluting stent ([[DES]]). A low DAPT score is associated with a higher risk of bleeding and a smaller reduction in ischemia. On the other hand, a high DAPT score translates into a greater reduction in ischemia, with a smaller risk of bleeding.
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| {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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| ! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
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| ! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[EHEC]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" | May present with [[fever]], [[chills]] [[vomiting]], [[diarrhea]], generalized [[pain]] or [[malaise]], and gastointestinal bleeding that follow an [[incubation period]] of 3-7 days. Unlike ''E. coli'', ''Shigella'' cannot ferment lactose or decarboxylate lysine.<ref name="NCBI">{{cite journal |last= Hale|first=TL |last2=Keusch|first2=GT |date=1996 |title=Shigella. In: Baron S, editor. Medical Microbiology. 4th edition. |url=http://www.ncbi.nlm.nih.gov/books/NBK8038/ |journal=Galveston (TX): University of Texas Medical Branch at Galveston|access-date=4 April 2015}}</ref>
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Ebola]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[fever]], [[chills]] [[vomiting]], [[diarrhea]], generalized [[pain]] or [[malaise]], and sometimes [[Internal bleeding|internal]] and external [[bleeding]], that follow an [[incubation period]] of 2-21 days.
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Typhoid fever]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[fever]], [[headache]], [[rash]], gastrointestinal symptoms, with [[lymphadenopathy]], relative [[bradycardia]], [[cough]] and [[leucopenia]] and sometimes [[sore throat]]. [[Blood]] and [[stool culture]] can confirm the presence of the causative bacteria.
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| | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Malaria]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |Presents with acute [[fever]], [[headache]] and sometimes [[diarrhea]] (children). A [[blood smear]]s must be examined for malaria parasites. The presence of [[parasites]] does not exclude a concurrent viral infection. An [[antimalarial]] should be prescribed as an [[empiric therapy]].
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lassa fever]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |Disease onset is usually gradual, with [[fever]], [[sore throat]], [[cough]], [[pharyngitis]], and [[facial edema]] in the later stages. [[Inflammation]] and exudation of the [[pharynx]] and [[conjunctiva]] are common.
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Yellow fever]] and other [[Flaviviridae]] '''
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| | style="padding: 5px 5px; background: #F5F5F5;" | Present with [[hemorrhage|hemorrhagic]] complications. [[Epidemiological]] investigation may reveal a pattern of disease [[transmission]] by an insect vector. Virus isolation and serological investigation serves to distinguish these [[viruses]]. Confirmed history of previous [[yellow fever]] [[vaccination]] will rule out [[yellow fever]].
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''Others'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |[[Viral hepatitis]], [[leptospirosis]], [[rheumatic fever]], [[typhus]], and [[mononucleosis]] can produce [[signs]] and [[symptoms]] that may be confused with [[Ebola]] in the early stages of [[infection]].
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| |}
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| ==References==
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| {{reflist|2}}
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| {{WH}}
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| {{WS}}
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