cardiomet-ce
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See archived programs at https://cardiometabolic-ce.com/
See archived programs at https://cardiometabolic-ce.com/
Please help us spread the word that we have posted an "encore" CE/#CME-accredited tweetorial from #AHA24 here on BlueSky! First post at bsky.app/profile/card...
December 14, 2024 at 6:59 PM
Please help us spread the word that we have posted an "encore" CE/#CME-accredited tweetorial from #AHA24 here on BlueSky! First post at bsky.app/profile/card...
25) Thank you for joining us for this update from #AHA2024! You may now proceed to cardiometabolic-ce.com/antithrombot... and collect your 🆓CE/#CME certificate! Thanks as always to @SidPatel (and to @sameralsaid!) for leading us through these hot-off-the-presses data!
LIVE UPDATE FROM AHA24: What do we know about antiplatelets added to anticoagulation in patients with AF? | Cardiometabolic-CE
cardiometabolic-ce.com
December 12, 2024 at 8:23 PM
25) Thank you for joining us for this update from #AHA2024! You may now proceed to cardiometabolic-ce.com/antithrombot... and collect your 🆓CE/#CME certificate! Thanks as always to @SidPatel (and to @sameralsaid!) for leading us through these hot-off-the-presses data!
24) @sidpatel & the #TIMI investigators further commented that if shown to be effective for prevention of ischemic events in ongoing Ph 3 trials, FXI inhibitor tx may be especially attractive for pts requiring #OAP – a subset of patients typically at much higher risk for bleeding.
December 12, 2024 at 8:23 PM
23) The authors concluded that #abelacimab tended to provide a greater absolute risk reduction for 🩸 in pts on #antiplatelet therapy than a conventional #DOAC, even beyond the difference seen in #AZALEA for pts treated overall. The #FXI hypothesis continues to be strengthened!
December 12, 2024 at 8:23 PM
23) The authors concluded that #abelacimab tended to provide a greater absolute risk reduction for 🩸 in pts on #antiplatelet therapy than a conventional #DOAC, even beyond the difference seen in #AZALEA for pts treated overall. The #FXI hypothesis continues to be strengthened!
22) The authors did note some limitations of this analysis, and pointed out that a Phase 3 study for efficacy AND safety of abelacimab is underway (#LILAC #TIMI-76, NCT05712200).
December 12, 2024 at 8:23 PM
22) The authors did note some limitations of this analysis, and pointed out that a Phase 3 study for efficacy AND safety of abelacimab is underway (#LILAC #TIMI-76, NCT05712200).
21) That same difference was present when considering #MB alone, and also when looking at net clinical benefit #NCB (composite of ischemic #SSE, MB, and all-cause death). Remarkable consistency favoring a #FXI-targeted approach!
December 12, 2024 at 8:23 PM
21) That same difference was present when considering #MB alone, and also when looking at net clinical benefit #NCB (composite of ischemic #SSE, MB, and all-cause death). Remarkable consistency favoring a #FXI-targeted approach!
20b) The interesting finding is that the addition of #OAP therapy to #anticoagulation created another differential between #rivaroxaban & #abelacimab: adding #OAP to riva significantly ⬆️ 🩸, but adding OAP to abelacimab did not!
December 12, 2024 at 8:23 PM
20b) The interesting finding is that the addition of #OAP therapy to #anticoagulation created another differential between #rivaroxaban & #abelacimab: adding #OAP to riva significantly ⬆️ 🩸, but adding OAP to abelacimab did not!
20a) So let’s look at the primary endpoint—centrally adjudicated combination of major 🩸 and clinically relevant non-major 🩸 #CRNMB by anticoagulant, stratified by concomitant #OAP. Overall, pts on #rivaraxaban had a higher bleeding rate. But we knew that already!
December 12, 2024 at 8:23 PM
20a) So let’s look at the primary endpoint—centrally adjudicated combination of major 🩸 and clinically relevant non-major 🩸 #CRNMB by anticoagulant, stratified by concomitant #OAP. Overall, pts on #rivaraxaban had a higher bleeding rate. But we knew that already!
17b) A particularly appealing potential of a #FXI/XIa-targeted #anticoagulant is the ⬇️ bleeding risk they seem to offer vs #DOACs. Might this translate to patients on concomitant #OAPs?
December 12, 2024 at 8:23 PM
17b) A particularly appealing potential of a #FXI/XIa-targeted #anticoagulant is the ⬇️ bleeding risk they seem to offer vs #DOACs. Might this translate to patients on concomitant #OAPs?
15) But what about those pts w/#AF who also have #CAD or have a #coronary #stent & therefore take oral antiplatelets #OAPs--including plain ol' #ASA, but also #P2Y12 inhibitors—drugs that carry an independent bleeding risk that is ⬆️in pts also taking a currently approved #OAC.
December 12, 2024 at 8:23 PM
13) The 🩸reduction with investigational #abelacimab compared with on-label #rivaroxaban was indeed impressive:
December 12, 2024 at 8:23 PM
13) The 🩸reduction with investigational #abelacimab compared with on-label #rivaroxaban was indeed impressive:
12) This trial was terminated prematurely due to a substantial reduction in bleeding with abelacimab as per the independent #DMC statement:
December 12, 2024 at 8:23 PM
12) This trial was terminated prematurely due to a substantial reduction in bleeding with abelacimab as per the independent #DMC statement:
11) Need an #AZALEA refresher? You can still earn credit by reviewing our live #tweeetorial from #AHA23 at cardiometabolic-ce.com/antithrombot.... AZALEA was a Ph 2 comparison of #abelacimab vs #rivaroxaban in pts w/#AF + mod/high risk of #stroke.
December 12, 2024 at 8:23 PM
11) Need an #AZALEA refresher? You can still earn credit by reviewing our live #tweeetorial from #AHA23 at cardiometabolic-ce.com/antithrombot.... AZALEA was a Ph 2 comparison of #abelacimab vs #rivaroxaban in pts w/#AF + mod/high risk of #stroke.
10) So @SidPatelMD was in the room here at #AHA24 for @cardiomet_CE as @TIMIStudyGroup #fellow Samer Al Said @sameralsaid presented a second preplanned analysis from #AZALEA TIMI_71, looking at concomitant use of #OAPs with either #abelacimab or #rivaroxaban.
December 12, 2024 at 8:23 PM
10) So @SidPatelMD was in the room here at #AHA24 for @cardiomet_CE as @TIMIStudyGroup #fellow Samer Al Said @sameralsaid presented a second preplanned analysis from #AZALEA TIMI_71, looking at concomitant use of #OAPs with either #abelacimab or #rivaroxaban.
9) Another small molecule, #asundexian, was being studied vs #apixaban for #SPAF in #OCEANIC_AF, but that trial was prematurely terminated due to inferior efficacy of the #FXIa inhibitor. See pubmed.ncbi.nlm.nih.gov/39225267/ & discussion by @CMichaelGibson at cardiometabolic-ce.com/antithrombot....
Asundexian versus Apixaban in Patients with Atrial Fibrillation - PubMed
Among patients with atrial fibrillation at risk for stroke, treatment with asundexian at a dose of 50 mg once daily was associated with a higher incidence of stroke or systemic embolism than treatment...
pubmed.ncbi.nlm.nih.gov
December 12, 2024 at 8:23 PM
9) Another small molecule, #asundexian, was being studied vs #apixaban for #SPAF in #OCEANIC_AF, but that trial was prematurely terminated due to inferior efficacy of the #FXIa inhibitor. See pubmed.ncbi.nlm.nih.gov/39225267/ & discussion by @CMichaelGibson at cardiometabolic-ce.com/antithrombot....
8b) New approaches for #stroke ⬇️ in #AFib have been #MAb against #FXI and small molecule inhibitors of #FXIa. Leading candidate from each of these categories currently in Ph 3 trials: MAb #abelacimab in #LILAC #TIMI-76 & small molecule #milvexian in #LIBREXIA_AF.
December 12, 2024 at 8:23 PM
8b) New approaches for #stroke ⬇️ in #AFib have been #MAb against #FXI and small molecule inhibitors of #FXIa. Leading candidate from each of these categories currently in Ph 3 trials: MAb #abelacimab in #LILAC #TIMI-76 & small molecule #milvexian in #LIBREXIA_AF.
8a) Since #FXI was identified as a potential target for #anticoagulation with less bleeding risk (supported by genomic & epidemiologic studies of ppl with inborn FXI deficiency & by animal studies), multiple approaches to inhibition of FXI zymogen or #FXIa activity are being studied.
December 12, 2024 at 8:23 PM
8a) Since #FXI was identified as a potential target for #anticoagulation with less bleeding risk (supported by genomic & epidemiologic studies of ppl with inborn FXI deficiency & by animal studies), multiple approaches to inhibition of FXI zymogen or #FXIa activity are being studied.
7) This allows us to see a potential way to "divide and conquer" this process UPSTREAM of the common pathway: by specifically inhibiting (only) #FXI:
December 12, 2024 at 8:23 PM
7) This allows us to see a potential way to "divide and conquer" this process UPSTREAM of the common pathway: by specifically inhibiting (only) #FXI:
6) Envisioning this requires rewiring our traditional thinking about the #coagulation cascade:
December 12, 2024 at 8:23 PM
6) Envisioning this requires rewiring our traditional thinking about the #coagulation cascade: