teg cath lab,plateletmapping
DESCRIPTION
TRANSCRIPT
Issues confronting the cardiologist :
• Damaged endothelial cells during balloon angioplasty
• Exposure of TF to the bloodstream
• Exposure of stent surfaces to the blood stream
• Explosion of enzymatic and platelet activation
• Extreme prothrombotic state
Cath Lab – Issues During Intervention
Release of ADP and TxA2
Activation of Platelet Receptors
Issues confronting the cardiologist :
• Adequate enzymatic anticoagulation and antiplatelet therapy
• Extent of inhibition by Aspirin or Plavix
• Does the patient need GPII/IIIa inhibitor drugs?
Cath Lab – Issues During Intervention
Targeted Receptor Inhibition
Ischemic Risk Stratification
Columbia Study
(Non-cardiac surgical)
Sinai Study
(Cath lab)
Aspirin Monitoring with TEG® Analysis
Plavix Monitoring with TEG® Analysis
TEG® Individualized Maintenance Regimen
Resistance to Aspirin and Plavix Prior to Intervention
For the cardiologist in the Cath Lab: He worries about resistance – but is it even needed?
The TEG® system can:
• Identify resistance to therapy
• Determine if therapy is being given at a therapeutic level
• Determine if the patient will need GPIIb/IIIa inhibition during intervention
Pre-Intervention Protocol
Recurrent Rate of Ischemic Events
TABLE 1 CUREPCI-CURE
CREDO
Percent recurrence of ischemia
Placebo (%)ASA Only
11.4 12.6 11.5
Study (%)ASA + Plavix
9.3 8.8 8.5
Reduction in recurrence of ischemia
Absolute (%) 2.1 3.8 3.0
Cath Lab – Issues Post Intervention
Cardiologist needs post intervention:
• Determine total platelet function
• Provide guidance in antiplatelet therapy
• Measure the effect of platelet inhibiting drugs
The TEG® system addresses these issues and individualizes the maintenance regimen post intervention.
Cath Lab – Issues Post Intervention
TEG Analysis with PlateletMapping™
• Determine total platelet function
• Provide guidance in maintenance antiplatelet therapy
Identify who needs it
Determine level of inhibition needed
Assess therapeutic level and/or resistance
Transition Protocol
Maintenance Protocol
Resistance to Aspirin and Plavix Market
Summary
• TEG analysis addresses hemostasis issues in both intervention and maintenance phases
• TEG measures total platelet function as well as inhibition levels of primary receptors
• TEG determines therapeutic levels
• TEG analysis with PlateletMapping enables personalized antiplatelet therapy management
Case Studies
Patient A
• 600mg Plavix® (approx. 1 hour after load) • MAP2: 51.4• %MA reduction: 4.9
Patient A
• 600mg Plavix® (approx. 2 hours after load) • MAP2: 42.8• %MA reduction: 47.8
Patient B
• 325mg aspirin + Integrilin® • MAP3: 17.8• %MA reduction: 100
Patient C
• Angiomax® + Integrilin® • MAP2: 11.6• %MA reduction: 100
Patient C
• Angiomax® + Integrilin® • MAP3: 8.5• %MA reduction: 100
Patient D
• 325mg aspirin + unknown drug • MAP3: 15.3• %MA reduction: 98.5
TEG® Analyzer Model 5000
Connectivity