About This Course

Module 1: New Anti-thrombotic Therapies for Non-Valvular Atrial Fibrillation, CAD, and Systemic Embolization

Direct oral anticoagulants (DOACs) are increasingly being used to treat patients with indications other than venous thromboembolism (VTE). This seminar will discuss newer guidelines that demonstrate DOAC use in patients with cardiac disorders. Antithrombotic therapy is a broad term encompassing anti-platelet medications and anticoagulants. The seminar will discuss data and newer practice patterns in which DOAC use in patients with coronary artery disease (CAD) is both permissible, and may offer more beneit over anti-platelet medications. The seminar will provide examples whereby the anti-platelet medication regimen must be altered in patients with a requirement for both a DOAC and anti-platelet therapy. We will inally discuss new research from the Cleveland Clinic that shows the platelet phenotype may evolve in cardiovascular disorders, and responses to antiplatelet medications may be less predictable.

Module 2: Peripheral Artery Disease – New Therapies for an Old Disease

Peripheral artery disease is an important global cardiovascular issue and is thought to affect over 120 million individuals across the world. PAD represents about 25% of the global burden of cardiovascular disease and in the US it is estimated that 8-11 millions of Americans are affected. Peripheral artery disease is thought to affect up to 54 million Indian citizens and is thought to afflict Indian diabetics at similar to higher rates as those found in European and US populations in the same age groups. This disease is commonly underdiagnosed which is unfortunate as it is the third leading cause of atherosclerotic cardiovascular disease only behind stroke and heart attack. Peripheral artery disease is a strong predictor of atherothrombotic events including major adverse cardiovascular events and major adverse limb events. Up to 20% of PAD patients will have an MI within 5 years. The risk of death and PAD patients at 5 years is anywhere between 15 and 30%. Identification of associated risk factors and early diagnosis is of the utmost importance. Less than 25% of the patients with peripheral arterial disease will have typical claudication symptoms, and a low threshold to diagnostic modalities such as ankle-brachial indices is valuable in diagnosing this entity. The importance of a thorough foot and vascular exam will be emphasized as well as consensus guidelines and generally accepted scoring systems for pulse exams and grading claudication symptoms. Other diagnostic modalities such as pulse volume recording, lower arterial duplex examinations, CT angiography, and more advanced investigations are often helpful in stratifying patients for therapy. The initial therapy for claudication is medical and includes a variety of antithrombotic choices, supervised or home exercise walking programs, and risk factor mitigation. Close vigilance and addressing the four major risk factors of atherosclerosis including smoking, diabetes, hyperlipidemia, and hypertension are important in the care of the patient with peripheral artery disease. New therapeutic options are now available from a pharmacological standpoint, including recent trials involving a direct oral anticoagulant in conjunction with an antiplatelet agent. This program will review the incidence, natural history, diagnosis, therapeutic options, and the role of atherosclerosis in peripheral artery disease.