الاسبرين يقي من تكرار ال VTE لكن بفاعلية اقل بكتير من ال
DOACs

Low-dose aspirin monotherapy provides modest benefit for secondary prevention of recurrent VTE after completion of anticoagulation, reducing recurrence risk by approximately 30% to 40%; however, it is substantially less effective than extended anticoagulation with DOACs.

#cardionotes

All beta- blockers used for treatment of HF are lipophilic, with extensive liver metabolism. Lipid solubility allows these compounds to reside longer and at higher concentrations in cell membranes.

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DOAC use in hepatic impairment

Child-Pugh class A: All DOACs appear to be safe.

Child-Pugh class B: Apixaban, dabigatran, and edoxaban can be used, and rivaroxaban should be avoided.

Child-Pugh class C: There is insufficient evidence to support the use of DOACs.

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Warfarin acts as a vitamin K antagonist (VKA) by inhibiting vitamin K epoxide reductase, thereby impairing the regeneration of active vitamin K and preventing γ-carboxylation of clotting factors II, VII, IX, and X, as well as proteins C and S.

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In acute HF

Inotropes are administered under electrocardiographic monitoring and for a limited period of time due to their detrimental effects including myocardial ischaemia and arrhythmogenesis.In patients pre- treated with beta blockers, levosimendan or milrinone are the preferable inotropes, but in patients with systolic blood pressure below 85 mmHg, both agents should be avoided or used in combination with other inotropes or a vasopressor due to their hypotensive effects.

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When AV surgery is indicated
Concomitant replacement of the aortic root or ascending aorta should be considered if the maximal diameter is ≥45 mm and the predicted surgical risk is low.

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The maximal daily dose for i.v. loop diuretics is generally considered to be:

* Furosemide: 400–600 mg/day (i.v.)
* Up to 1000 mg/day may be considered in patients with severely impaired kidney function.

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β-blockers, preferably non-selective β-blockers (nadolol or propranolol), are recommended in patients with Long QT Syndrome (LQTS) and documented QT interval prolongation to reduce the risk of arrhythmic events.

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Diabetes mellitus
Chronic kidney disease
Systemic lupus erythematosus
Rheumatoid arthritis
Hypothyroidism
دول اشهر الامراض اللي بترفع الدهون الثلاثية

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لو استخدمت
Triple antithrombotic therapy or dual antithrombotic therapy
وفيهم NOAC

اللي ممكن تقلل جرعته هو ال
Rivaroxaban or dabigatran

‏For both TAT and DAT regimens, the recommended doses for the NOACs are as follows: Apixaban 5 mg b.i.d., Dabigatran 110 mg or 150 mg b.i.d., Edoxaban
60 mg o.d., Rivaroxaban 15 mg or 20 mg o.d.

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Thromboembolism prophylaxis (e.g. with
LMWH) is recommended in acute HF patients not already anticoagulated and with no contraindication to anticoagulation.

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اختيار مضاد الصفائح في مرضى ال
ACS

النقطة الاولى
كل المرضى بياخذوا اسبرين (ما لم يكن ممنوع)

النقطة التانيه هنضيف واحد من ال
P2Y12 inhibitors

واحد من التلاته
Clopidogrel
Ticagrelor
Prasugrel

لو مريض ازمة قلبية، ACS و هيدخل قسطرة يبقى نضيف ال
Ticagrelor or prasugrel

يفضل عن ال
Clopidogrel
اللي هو البلافكس

ودا مبني على ال
PLATO trial
TRITON-TIMI 38 trial

اذا كان واحد من الاتنين مش متاح او ممنوع يتم استخدام البلافكس

مريض ال STEMI اللي بياخد مذيب بياخد في الاساس بلافكس (مش بريليك)

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2026 ACC/ACC ECDP for management of HFpEF

The new ESC guidelines