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Here is a synopsis of the baseline characteristics of patients that were included in this study’s population (2) #PeriPRNJC

The rate of peri-procedural stroke and primary end point was significantly higher among patients who received clopidogrel bolus. (3) #PeriPRNJC

Patients who received clopidogrel bolus were more likely to be symptomatic. Among asymptomatic patients, there was a higher rate of death associated with patients who received clopidogrel bolus at 10 years. (4) #PeriPRNJC

Primary end-point-free survival rates were 86.7% and 93.2% at 5 years for patients who received clopidogrel bolus and sustained clopidogrel pretreatment respectively. (5) #PeriPRNJC

The stroke-free survival rates were 88% and 94% at 5 years for patients who received clopidogrel bolus and for those who received sustained clopidogrel pretreatment respectively. (6) #PeriPRNJC

In the Cox proportional hazards analysis, the risk of primary end point was significantly higher in patients who received clopidogrel bolus (7) #PeriPRNJC

❓Question for the audience ❓ Did you expect that clopidogrel bolus doses were more common amongst symptomatic patients?

Discussion: Compared with patients who are on sustained pretreatment for ≥48 hours, patients who received boluses (≥4 hours) were more likely to have periprocedural stroke and composite of stroke, MI, or death or ipsilateral stroke within 4 years after randomization.

Results do not support the use of clopidogrel bolus as used in the CREST as a substitute for sustained clopidogrel pretreatment. The primary end point–free survival and stroke-free survival were lower in patients who received clopidogrel bolus. (2) #PeriPRNJC

Some limitations of the study include: (3) #PeriPRNJC

An option for future practices or trials, may be to use higher doses and measure platelet reactivity point of care testing after clopidogrel bolus to ensure adequate platelet inhibition before CAS. (4) #PeriPRNJC

Further studies to evaluate other options such as ticagrelor to CAS are also warranted when sustained clopidogrel treatment is not possible. (5) #PeriPRNJC

❓Question for the audience ❓Would you consider using a different agent such as ticagrelor prior to CAS placement? #PeriPRNJC

For the audience: Do you have any questions for our presenter Darryl. ❓ Please comment below!!

Thank you for joining us for another #PeriPRNJC and thanks to our presenter Darryl. for preparing today's journal club! We'll check back to answer any remaining questions!

Meet your 2022-2023 PeriPRN Chair-Elect Dustin Carneal!

We love how supportive and collaborative our members are! Great job 🙌🏻

👀 check out the Pharmacy To Dose: The Critical Care Podcast podcast on both Perioperative Emergencies I & II where you can hear Sara J. Hyland, Eric Johnson, Gourang Patel, & Rachel Wolfe share their insights!

Checkout the recent ACCP Periop PRN webinar where member Tim Jacisin discussed Updates in GLP-1 Management in Perioperative Medicine.   For more information or to view the webinar in its entirety please visit our Communities Tab (communities.accp.com/viewdocument/u…).

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