1. Disease State Platelet Presentation Volume 2 Presented By: Name

2. An ACS Case Study: Mr. Jacobs

3. Case Study: Pre-Angiogram Lesion in the mid LADLesion in the mid LAD Proceeded with PCIProceeded with PCI

4. PCI SuccessfulPCI Successful Post PCI MedsPost PCI Meds ACE inhibitorACE inhibitor Beta-blockerBeta-blocker StatinStatin Dual antiplatelet therapyDual antiplatelet therapy Case Study: Post-Angiogram

5. Post PCI Arterial Environment Arterial wall damage and plaque disruption Exposure of thrombotic substrates SMC

6. Stent Thrombosis AdhesionActivationAggregation

7. Dual Antiplatelet Therapy in the PCI Patient Manages the prothrombotic environment Reduces risk of MI and death Platelet Monolayer

8. The Progression of Atherosclerotic Disease Continues Plaque formation is likely to continue in this ACS patient

9. Spontaneous Rupture and Thrombus Formation

10. Premature Discontinuation of Dual Antiplatelet TherapyAtherothrombosis

11. Increased risk of MI and death

12. Minimizing the Risk of Atherothrombotic Events in the ACS patient Percutaneous Coronary InterventionPercutaneous Coronary Intervention Long-term medical managementLong-term medical management Dual antiplatelet therapyDual antiplatelet therapy Lifestyle changesLifestyle changes Smith SC Jr, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). American Heart Association Website. Available at: http://www.americanheart.org.

13. Dual Antiplatelet Therapy Continued in this ACS Patient Platelet monolayer is formed and activation is better managed

14. Managing the Risks: A Summary Long term dual antiplatelet therapy helps prevent atherothrombosis caused by PCI and spontaneous plaque rupture

15. ACC/AHA/SCAI 2005 Guidelines for PCI Current guidelines recommend dual antiplatelet therapy be given ideally up to 12 months in patients who have undergone PCI and who are not at a high risk of bleeding. Smith SC Jr, Feldman TE, Hirschfeld JW Jr, Jacobs AK, Kern MJ, King SB III, Morrison DA, O’Neill WW, Schaff HV, Whitlow PL, Williams DO. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). American Heart Association Website. Available at: http://www.americanheart.org.