Activity Overview
Balance between efficacy and safety is a major concern in patients on dual antiplatelet therapy. Identifying and managing the risks that may negatively affect this balance can potentially minimize the incidence of morbidity and/or mortality among these patients. Although monotherapy with either aspirin or specific antiplatelet agents has been validated in secondary prevention for patients with percutaneous coronary intervention, dual antiplatelet therapy appears to be the most beneficial therapy. Clinicians must balance anti-ischemic efficacy with the need to minimize the risk of serious bleeding complications (eg, hemorrhage). Issues related to safety include timing of the dose, duration of infusion, drug compatibility, errors in estimating a patient’s weight and/or age, failure to adjust the dosage based upon renal function, and errors in drug preparation.

In addition, there are several large ongoing clinical trials, including PLATO, COMMIT, CLARITY, JUMBO, and TRITON. Results from these trials need to be communicated to cardiologists in order for them to be able to make the most appropriate clinical decisions based on the latest evidence-based medicine.

This educational activity will summarize the current state of dual antiplatelet therapy, its challenges, and what the future holds.

Goal
This educational activity will provide cardiologists with an update on dual antiplatelet therapy, its challenges, and ongoing advancements in this field.

Target Audience
This activity is designed for cardiologists. No prerequisites required.

Learning Objectives
At the conclusion of this activity, the participant should be able to:

• DEFINE the current status and challenges for dual antiplatelet therapy.
• RECOGNIZE the ongoing clinical trials for dual antiplatelet therapy and the impact of the emerging therapies on antiplatelet resistance.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CME Information
Accreditation Statement
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: October 30, 2009. Expiration date: October 30, 2011.

Estimated time to complete activity: 1 hour.

Activity Format
Two-session podcast.

Faculty
Jon R. Resar, MD (Chair)
Associate Professor of Medicine/Cardiology
Director, Adult Cardiac Catheterization Laboratory
Director, Interventional Cardiology
The Johns Hopkins Hospital
Baltimore, Maryland

Jeffrey J. Rade, MD
Associate Professor of Medicine
Division of Cardiology
The Johns Hopkins University School of Medicine
Baltimore, MD

Stephen D. Wiviott, MD, FACC
Assistant Professor of Medicine
Cardiovascular Division
Brigham and Women’s Hospital
Harvard Medical School
Investigator, TIMI Study Group
Boston, Massachusetts

Full Disclosure Policy Affecting CME Activities
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The participating faculty reported the following:

Dr Resar reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Dr Rade reports receiving grants/research support and honoraria from Siemens Healthcare Diagnostics Inc.

Dr Wiviott reports receiving grants/research support from Daiichi Sankyo, Inc, Eli Lilly and Company, and Schering-Plough Corporation; serving as a consultant for AstraZeneca, Bristol-Myers Squibb Company, Novartis Pharmaceuticals Corporation, Portola Pharmaceuticals, Inc, Sanofi-Aventis; and receiving honoraria from AstraZeneca, Daiichi Sankyo, Inc, Eli Lilly and Company, Merck & Co, Inc, Novartis Pharmaceuticals Corporation, and Sanofi-Aventis.

Off-Label Product Discussion:
The audience is advised that some audio content in this CME activity contains reference(s) to unlabeled or unapproved uses of drugs or devices.

Dr Wiviott–clopidogrel, prasugrel, and ticagrelor.

All other faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Disclaimer Statement
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Internet CME Policy
The Office of Continuing Medical Education (CME) at The Johns Hopkins University School of Medicine is committed to protect the privacy of its members and customers. Johns Hopkins University School of Medicine CME maintains its Internet site as an information resource and service for physicians, other health professionals, and the public. Continuing Medical Education at The Johns Hopkins University School of Medicine will keep your personal and credit information confidential when you participate in a CME Internet-based activity. Your information will never be given to anyone outside of The Johns Hopkins University School of Medicine’s CME activity. CME collects only the information necessary to provide you with the services that you request.

Podcast Activity
The following activity consists of 2 podcasts and a CME test. After listening to the 2 podcasts, participants may receive credit by completing the CME test, evaluation, and receiving a score of 70% or higher.