closing thoughts

Deepak Bhatt, MD, MPH: This has been a great programme. I learned a lot. We have covered a lot of details about anticoagulant therapy, coronary artery disease [CAD]and peripheral artery disease [PAD] Generally. Let me turn to our distinguished team for some closing thoughts. I’ll start with you, Manish. No end points [that] Want to make it to the public?

Manish Patel, MD: Deepak, it was fun and exciting. It’s fun talking to people about clues to the things we see. We have learned over the past decade that vascular disease is unfortunately still the leading cause of cardiovascular motility problems and mortality. Since there are more options, which is a good thing, we have to get the right dose for the right patient at the right time. Part of that is understanding the risks and benefits of the risks we’ve been talking about. With regard to patients with multiple vascular disease, and patients with an extensive risk of thrombosis, it is important to understand how you can make them have better outcomes. We talked about that today. Hopefully this is something people will take home.

Deepak Bhatt, MD, MPH: Really valuable points. Amy?

Amy Pollack, MD: I agree. It was a wonderful painting. I am glad to be a part of this. My home post would be to focus on identifying these polyvascular patients. Since they are high-risk patients, it is important not to focus on coronary artery disease. But if patients have coronary artery disease and vascular disease in another area, this is the height of our risk. Furthermore, diabetes will be at the highest risk of cardiovascular disease, so we need to talk to our patients about the fact that they are at greater risk and how that guides our recommendations for changing medications. Often patients can, for understandable reasons, resist the urge to add another drug. But part of the patient-centered decision-making process is educating them that this is why this goes a long way.

Deepak Bhatt, MD, MPH: We need to educate the medical community about those risks that define multiple vascular diseases, and diabetes is a real risk amplifier. Great points. Eric, any closing thoughts?

Eric Sisimsky, MD: This was a great discussion. For everyone watching this, it is important for us not to be afraid to make a change in our practice. We’ve been set in our ways for a long time, but we have this data piling up. It’s time to be open about making changes that benefit our patients. We heard today that there are many factors that can improve long-term cardiovascular and extremity risk outcomes and improve the care of our patients, so it was a great discussion.

Deepak Bhatt, MD, MPH: Totally agree and easy Any final ideas?

Plain Parikh, MD: This is really important. What Eric just said is that we’ve been in this pattern of using dual antiplatelet therapy for extended periods of time with little evidence, especially in the PAD community, which is the predominant part of my practice. It is great that we have strong evidence to support the use of dual pathway inhibition. We need to get the message across to our referring physicians and patients that this is the way forward to improve risk.

Deepak Bhatt, MD, MPH: Fabulous. Mark, you’ll have the last word.

Marc P. Bonaca, MD, MPH: It is such an honor to be a part of this panel. We’ve learned that we have a gap in terms of evidence and how we treat our patients. Part of that is that we have a lot of patients to see. We are all very busy doctors. Everyone wants to do their best. But understanding which patient is most at risk and what is the best clue should be at the top of your mind when you see patients in your clinic, and multiple vascular diseases reverberate. I learned this term from you, Deepak, many years ago. It has been shown in every study to be a strong risk marker and beneficial for some of these strategies and other things like diabetes. We need to take that into the clinic and start treating our patients better.

Deepak Bhatt, MD, MPH: I can’t accept more. We hope the audience will find this exchange of ideas useful, interesting and educational. Hopefully these are things you can take into your practice. As I mentioned, I learned a lot. The last point I’m going to make is that when you think of coronary artery disease, think of the entire patient. For that patient you see for a particular case, that might be the problem in the office for that day. But they may have other risk factors. They may have plaque in areas of other arteries. We talked a lot in this session about multiple vascular diseases, but keep in mind that CHD, PAD, and cerebrovascular disease can coexist. Even though a patient may see you for angina on that office visit or in the hospital, consider all of those associated risks. If you identify those associated risks, you understand that he is a high-risk patient, the kind of patient for whom we want to do everything we can to reduce their risk, including extensive lifestyle modification. Furthermore, in many cases pharmacotherapy, prudent polypharmacy, and in some cases procedural care, are all complementary rather than competitive approaches.

Thank you to all of you on our team and our audience for such a rich and informative discussion. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming content HCPLive® Peer exchange And other great content right in your inbox.

Text edited for clarity

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