CardioExchange Archive

Several Cardiology Fellows who are attending ACC.12 this week are blogging together on CardioExchange.  The Fellows include Tariq Ahmad, Bill Cornwell, Megan Coylewright, Jeremiah Depta, and John Ryan (moderator). Read the previous post here. For more on Fellows’ experiences in presenting research, see Amit Shah’s post from AHA in 2011, John Ryan’s post from AHA in 2010, and his interview in 2011 with Thomas Ryan].

Monday morning, my co-author Dr. Jeffrey Fowler and I had the opportunity to present our study, “Clinical Outcomes Using a Platelet-function Guided Approach for Prevention of Ischemic Events in Patients with Stroke or TIA.”

The study was a retrospective observational study of ischemic stroke and TIA patients on aspirin and/or clopidogrel who underwent platelet function testing and whose antiplatelet therapy was either maintained (i.e. same dosages) or modified (i.e. increased the dosage or added/changed to a more potent agent). We found that antiplatelet therapy modification was associated with increased adverse outcomes, mainly driven by an increase in bleeding events, compared with no modification.

The project was conceptualized during my intern year at Cleveland Clinic. I was on the stroke service and was asked by the attendings to order platelet function tests to assess for adequate inhibition in ischemic stroke and TIA patients. I had been reading about platelet function testing for several years before this experience and began working on a review article on this topic with my mentor, Dr. Deepak Bhatt. I remember asking the neurology attendings as to the available evidence for this therapeutic approach in this patient population and many of them recognized that the evidence was lacking. With the help of Dr. Fowler, we were able to collect detailed data on clinical outcomes with ~ 4.5 year follow-up. It was incredibly gratifying to finally present the data from one of the first clinical research projects I had conceptualized during my intern year.

We presented in the session entitled, How to Pick your Antiplatelet Therapy. When we arrived, we realized that ours was one of the few studies that concluded that adjusting antiplatelet therapy based on platelet function testing was not helpful, even potentially harmful, in our patient population.  Dr. Fowler and I both felt we would be met with significant criticisms. The moderator for the session was Dr. Dominick Angiolillo, who is a luminary in the field of antiplatelet therapy and platelet function testing. I have read numerous articles by him and felt very honored to have him review our study. To our surprise, we did not meet with an incredible amount of criticism from him and other individuals who stopped by our poster. We were very careful to mention the study limitations associated with our study, which I think helped to ease any major reproaches.

The opportunity to present your research and get feedback from experts in the field is invaluable. I have presented at prior ACC poster sessions, but this was my first moderated poster session. I applaud the ACC for assigning experts to moderate the sessions and give feedback to the presenters, many of whom are residents/fellows/junior faculty.  The interactions are vital and allow one to get instant feedback and discussion about their research project.

All in all, it was a fantastic experience to finally present data on a project that was started “many” years ago and too many “calls” to count.