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Case Challenges With Antiplatelet Therapy

  • Authors: Deepak L. Bhatt, MD, MPH; Marc P. Bonaca, MD, MPH; Roxana Mehran, MD; Philippe Gabriel Steg, MD
  • CME Released: 12/28/2022
  • Valid for credit through: 12/28/2023
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  • Credits Available

    Physicians - maximum of 1.50 AMA PRA Category 1 Credit(s)™

    You Are Eligible For

    • Letter of Completion

Target Audience and Goal Statement

This activity was developed for clinicians who manage patients with cardiovascular disease.

The goals of this program are for clinicians to:

  1. Personalize the intensity and duration of dual antiplatelet therapy (DAPT) to optimize clinical outcomes after percutaneous coronary intervention (PCI)
  2. Incorporate more potent and extended DAPT into the treatment of patients with type 2 diabetes
  3. Utilize antiplatelet therapy strategies to reduce bleeding risk in patients with high bleeding risk (HBR) after PCI
  4. Explain considerations that help determine the choice between DAPT and dual pathway inhibition (DPI), and use extended dual therapy in appropriate patients to reduce ischemic risk

Learning Objectives

Upon completion of this activity, participants will:

  1. Discuss the multiple factors to be considered when assessing ischemic risk and bleeding risk after PCI
  2. Recognize diabetes mellitus as a criterion for increased ischemic risk
  3. Identify patients at HBR and interpret clinical evidence using bleeding risk-reduction strategies with antiplatelet therapy
  4. Describe factors for consideration of extended DAPT or DPI and explain clinical trial results


Voxmedia strives to ensure fair-balance, independence, objectivity, and scientific rigor in all directly or jointly sponsored educational activities. All prospective faculty are required to disclose to Voxmedia all financial relationships for the preceding 24 months (1) with any commercial interest producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients AND (2) with any commercial supporters prior to participating in the planning of an activity or developing content. Only after Voxmedia mitigates all financial relationships may faculty receive approval to participate, and are expected to contribute evidence-based material. Faculty are required to indicate areas of their presentation that are based on professional opinion vs. guidelines, meta-analysis. All information submitted will be peer-reviewed. The intent of this disclosure is not to prevent faculty from participating, but rather to provide learners with information on which they can make their own judgment of commercial bias. Voxmedia will disclose to learners that all relevant financial relationships have been mitigated in either written materials, visually and/or verbally. It remains for the audience to determine whether the speaker's interests or relationships may influence the presentation. Speakers must make a meaningful disclosure to the audience of their discussions of any unlabeled or investigational use(s) of drugs or devices.


  • Deepak L. Bhatt, MD, MPH

    Executive Director of Interventional Cardiovascular Programs
    Brigham and Women’s Hospital Heart & Vascular Center
    Professor of Medicine
    Harvard Medical School
    Boston, Massachusetts


    Deepak L. Bhatt, MD, MPH, has the following relevant financial relationships:
    Advisory Board: AngioWave; Bayer; Boehringer Ingelheim; Cardax; CellProthera; Cereno Scientific; Elsevier Practice Update Cardiology; High Enroll; Janssen; Level Ex; McKinsey; Medscape Cardiology; Merck; MyoKardia; NirvaMed; Novo Nordisk; PhaseBio; PLx Pharma; Regado Biosciences; Stasys
    Board of Directors: AngioWave (stock options); Boston VA Research Institute; Bristol Myers Squibb (stock); DRS.LINQ (stock options); High Enroll (stock); Society of Cardiovascular Patient Care; TobeSoft
    Chair: Inaugural Chair, American Heart Association Quality Oversight Committee
    Consultant: Broadview Ventures
    Data Monitoring Committees: Acesion Pharma; Assistance Publique-Hôpitaux de Paris; Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott); Boston Scientific (Chair, PEITHO trial); Cleveland Clinic (including for the ExCEED trial, funded by Edwards); Contego Medical (Chair, PERFORMANCE 2); Duke Clinical Research Institute; Mayo Clinic; Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo; for the ABILITY-DM trial, funded by Concept Medical); Novartis; Population Health Research Institute; Rutgers University (for the NIH-funded MINT Trial)
    Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News,; Chair, ACC Accreditation Oversight Committee); Arnold and Porter law firm (work related to Sanofi/Bristol-Myers Squibb clopidogrel litigation); Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring); Belvoir Publications (Editor in Chief, Harvard Heart Letter); Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees); Cowen and Company; Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals); HMP Global (Editor in Chief, Journal of Invasive Cardiology); Journal of the American College of Cardiology (Guest Editor; Associate Editor); K2P (Co-Chair, interdisciplinary curriculum); Level Ex;
    Medtelligence/ReachMD (CME steering committees); MJH Life Sciences; Oakstone CME (Course Director, Comprehensive Review of Interventional Cardiology); Piper Sandler; Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer); Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention); Society of Cardiovascular Patient Care (Secretary/Treasurer); WebMD (CME steering committees); Wiley (steering committee)
    Other: Clinical Cardiology (Deputy Editor); NCDR-ACTION Registry Steering Committee (Chair); VA CART Research and Publications Committee (Chair)
    Patent: Sotagliflozin (named on a patent for sotagliflozin assigned to Brigham and Women's Hospital who assigned to Lexicon; neither I nor Brigham and Women's Hospital receive any income from this patent.)
    Research Funding: Abbott; Acesion Pharma; Afimmune; Aker Biomarine; Amarin; Amgen; AstraZeneca; Bayer; Beren; Boehringer Ingelheim; Boston Scientific; Bristol Myers Squibb; Cardax; CellProthera; Cereno Scientific; Chiesi; CinCor; CSL Behring; Eisai; Ethicon; Faraday Pharmaceuticals; Ferring Pharmaceuticals; Forest Laboratories; Fractyl; Garmin; HLS Therapeutics; Idorsia; Ironwood; Ischemix; Janssen; Javelin; Lexicon; Lilly; Medtronic; Merck; Moderna; MyoKardia; NirvaMed; Novartis; Novo Nordisk; Owkin; Pfizer, Inc.; PhaseBio; PLx Pharma; Recardio; Regeneron; Reid Hoffman Foundation; Roche; Sanofi; Stasys; Synaptic; The Medicines Company; Youngene; 89Bio
    Royalties: Elsevier (Editor, Braunwald’s Heart Disease)
    Site Co-Investigator: Abbott; Biotronik; Boston Scientific; CSI; Endotronix; Philips; St. Jude Medical (now Abbott); SpectraWAVE; Svelte; Vascular Solutions
    Trustee: American College of Cardiology
    Unfunded Research: FlowCo; Takeda


  • Marc P. Bonaca, MD, MPH

    Executive Director, CPC Clinical Research
    Director of Vascular Research
    Associate Professor of Medicine
    William R. Hiatt Endowed Chair in Cardiovascular Research
    University of Colorado School of Medicine
    Aurora, Colorado


    Marc P. Bonaca, MD, MPH, has the following relevant financial relationships:
    Dr. Bonaca is the Executive Director of CPC, a non-profit academic research organization affiliated with the University of Colorado, that receives:
    Research grant/consulting funding: Abbott; Agios; Alexion Pharma; Alnylam; Amgen; Angionetics; ARCA Biopharma; Array; AstraZeneca; Atentiv; Audentes; Bayer; Better Therapeutics; Brigham and Women’s Hospital; Bristol Myers Squibb; Cardiol Therapeutics; CellResearch; Cook; Cook Medical; CSL Behring; Eidos Therapeutics; EP Trading Co; Esperion Therapeutics; EverlyWell; Faraday; Fortress Biotech; HDL Therapeutics; Heartflow; Hummingbird Bioscience; Insmed; Janssen; Kowa Research; Lexicon; Merck; Medtronic; Moderna; Novate Medical; Novo Nordisk; Pfizer, Inc.; PhaseBio; PPD Development; Prairie Education and Research; Prothena Biosciences; Regeneron; Regio Biosciences; Sanifit Therapeutics; Sanofi; Smith and Nephew; Stealth BioTherapeutics; University of Colorado; Worldwide Clinical Trials; WraSer; Yale Cardiovascular Research Group
    Stock (Dr. Bonaca): Medtronic; Pfizer, Inc
    Consultant: Audentes

  • Roxana Mehran, MD

    Mount Sinai Endowed Professor of Cardiovascular Clinical Research and Outcomes
    Professor of Medicine, and Population Health Science and Policy
    Director of Interventional Cardiovascular Research and Clinical Trials
    Director of Women’s Cardiovascular Health at Mount Sinai
    Icahn School of Medicine at Mount Sinai
    New York, New York


    Roxana Mehran, MD, has the following relevant financial relationships:
    Research Funding to Institution: Abbott; Abiomed; Alleviant Medical; AM-Pharma; Amgen; Arena; AstraZeneca; Atricure; Bayer; Biosensors; Biotronik; Boston Scientific; Bristol Myers Squibb; CardiaWave; CeloNova; Chiesi; Concept Medical; CSL Behring; Cytosorbents; Daiichi Sankyo; Element Science; Faraday; Humacyte; Idorsia Pharmaceuticals; Janssen; Medtronic; Novartis; OrbusNeich; PhaseBio; Philips; Pi-Cardia; RenalPro; Shockwave; Vivasure; Zoll
    Personal Fees: Cine-Med Research; WebMD
    Stock: Applied Therapeutics; ControlRad (spouse); Elixir Medical; STEL
    Scientific Advisory Board: AMA; ACC; (BOT Member); SCAI (Women in Innovations Committee Member), JAMA Associate Editor; Faculty CRF (no fee)

  • Philippe Gabriel Steg, MD

    Professor of Cardiology
    Universite Paris—Cite
    Departement de Cardiologie
    Hopital Bichat
    Paris, France


    Philippe Gabriel Steg, MD, has the following relevant financial relationships:
    Research Grants: Amarin; Bayer; Sanofi; Servier
    Clinical Trials (Steering Committee, CEC, DSMB): Amarin; AstraZeneca; Bayer; Boehringer Ingelheim; Bristol Myers Squibb; Idorsia; Novartis; Pfizer, Inc.; Sanofi; Servier
    Consultant/Honoraria: Amarin; Amgen; Bristol Myers Squibb/Myokardia; Novo Nordisk; Regeneron
    Senior Associate Editor: Circulation


  • John F. Kocsis, PhD

    Hazlet, New Jersey


    John F. Kocsis, PhD, has no relevant financial relationships.

Accreditation Statements

Voxmedia LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    For Physicians

  • Voxmedia LLC designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of  80%  on the post-test.

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  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. In addition, you must complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.


Case Challenges With Antiplatelet Therapy

Authors: Deepak L. Bhatt, MD, MPH; Marc P. Bonaca, MD, MPH; Roxana Mehran, MD; Philippe Gabriel Steg, MDFaculty and Disclosures

CME Released: 12/28/2022

Valid for credit through: 12/28/2023


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