#!/usr/bin/env python3
"""
Antiplatelet Drugs in Cardiovascular Disease - Comprehensive Presentation Builder
"""

import subprocess, json, base64, io, os
from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
from pptx.oxml.ns import qn
from pptx.oxml import parse_xml
from lxml import etree
from io import BytesIO
import requests

# ─── Color Palette ────────────────────────────────────────────────────────────
DARK_BLUE    = RGBColor(0x0D, 0x2B, 0x5E)   # deep navy
MED_BLUE     = RGBColor(0x1A, 0x5E, 0xAB)   # medium blue
LIGHT_BLUE   = RGBColor(0xD6, 0xE8, 0xF7)   # pale blue
ACCENT_RED   = RGBColor(0xC0, 0x39, 0x2B)   # accent red
ACCENT_TEAL  = RGBColor(0x00, 0x7A, 0x87)   # teal
ACCENT_GREEN = RGBColor(0x1E, 0x8A, 0x44)   # green
WHITE        = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_GRAY   = RGBColor(0xF4, 0xF6, 0xF8)
MID_GRAY     = RGBColor(0x7F, 0x8C, 0x8D)
DARK_GRAY    = RGBColor(0x2C, 0x3E, 0x50)
AMBER        = RGBColor(0xF3, 0x9C, 0x12)
ORANGE       = RGBColor(0xE6, 0x7E, 0x22)

prs = Presentation()
prs.slide_width  = Inches(13.333)
prs.slide_height = Inches(7.5)
blank = prs.slide_layouts[6]

# ─── Helper utilities ──────────────────────────────────────────────────────────

def add_rect(slide, x, y, w, h, fill_color, line_color=None, line_width=0):
    shape = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h))
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_color
    if line_color:
        shape.line.color.rgb = line_color
        shape.line.width = Pt(line_width)
    else:
        shape.line.fill.background()
    return shape

def add_text(slide, text, x, y, w, h, font_size=14, bold=False, color=DARK_GRAY,
             align=PP_ALIGN.LEFT, italic=False, wrap=True, anchor=MSO_ANCHOR.TOP):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.vertical_anchor = anchor
    tf.margin_left  = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top   = Pt(2)
    tf.margin_bottom= Pt(2)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.size = Pt(font_size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    run.font.name = "Calibri"
    return tb

def add_multiline(slide, lines, x, y, w, h, font_size=12, color=DARK_GRAY,
                  bold_first=False, line_space=1.15, align=PP_ALIGN.LEFT):
    """lines: list of (text, bold, color_override_or_None)"""
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left  = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top   = Pt(2)
    tf.margin_bottom= Pt(2)
    for i, item in enumerate(lines):
        if isinstance(item, str):
            text, bold, col = item, False, color
        elif len(item) == 2:
            text, bold = item; col = color
        else:
            text, bold, col = item
        if i == 0:
            p = tf.paragraphs[0]
        else:
            p = tf.add_paragraph()
        p.alignment = align
        p.space_after = Pt(2)
        run = p.add_run()
        run.text = text
        run.font.size = Pt(font_size)
        run.font.bold = bold
        run.font.color.rgb = col
        run.font.name = "Calibri"
    return tb

def add_bullet_box(slide, title, bullets, x, y, w, h,
                   title_size=13, bullet_size=11,
                   box_color=LIGHT_BLUE, title_color=DARK_BLUE,
                   bullet_color=DARK_GRAY):
    add_rect(slide, x, y, w, h, box_color)
    add_text(slide, title, x+0.08, y+0.06, w-0.16, 0.32,
             font_size=title_size, bold=True, color=title_color)
    y_cur = y + 0.38
    for b in bullets:
        add_text(slide, f"• {b}", x+0.1, y_cur, w-0.2, 0.25,
                 font_size=bullet_size, color=bullet_color, wrap=True)
        y_cur += 0.24
    return y_cur

def download_image(url, path):
    try:
        r = requests.get(url, timeout=10)
        with open(path, 'wb') as f:
            f.write(r.content)
        return True
    except Exception as e:
        print(f"Image download failed: {e}")
        return False

# Download textbook images
img1_url = "https://cdn.orris.care/cdss_images/9fd1a3bba0bc708dcedb82ad2004cedfd25fe6e83bf6b5a0e8efe7cc4e09f32a.png"
img2_url = "https://cdn.orris.care/cdss_images/ce5409b2c31470519829093e582fc21ef28cfa8e9b2514f44a38ac96f76a4e83.png"
img1_path = "/tmp/workspace/antiplatelet-pptx/aspirin_moa.png"
img2_path = "/tmp/workspace/antiplatelet-pptx/p2y12_moa.png"
download_image(img1_url, img1_path)
download_image(img2_url, img2_path)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 1 — TITLE SLIDE
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_BLUE)
add_rect(slide, 0, 5.3, 13.333, 2.2, MED_BLUE)
add_rect(slide, 0.5, 1.0, 12.333, 0.06, ACCENT_TEAL)  # divider line

add_text(slide, "ANTIPLATELET DRUGS", 0.5, 1.3, 12.333, 1.3,
         font_size=44, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_text(slide, "in the Management of Cardiovascular Disease",
         0.5, 2.55, 12.333, 0.7, font_size=24, bold=False, color=LIGHT_BLUE,
         align=PP_ALIGN.CENTER)
add_rect(slide, 4.5, 3.4, 4.333, 0.06, ACCENT_TEAL)
add_text(slide, "Dosage • Mechanisms • Treatment Duration • Guidelines",
         0.5, 3.6, 12.333, 0.5, font_size=16, bold=False, color=RGBColor(0xBB, 0xD6, 0xF0),
         align=PP_ALIGN.CENTER)
add_text(slide, "Based on: Harrison's 22e | Washington Manual | Current Surgical Therapy | Lippincott Pharmacology",
         0.5, 5.55, 12.333, 0.4, font_size=10, color=RGBColor(0xAA, 0xCC, 0xEE),
         align=PP_ALIGN.CENTER)
add_text(slide, "2025 ACC/AHA ACS Guidelines | 2026 ACC Scientific Statement",
         0.5, 5.95, 12.333, 0.35, font_size=10, color=RGBColor(0xAA, 0xCC, 0xEE),
         align=PP_ALIGN.CENTER)
add_text(slide, "July 2026", 0.5, 6.85, 12.333, 0.35,
         font_size=11, color=RGBColor(0xBB, 0xBB, 0xCC), align=PP_ALIGN.CENTER)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 2 — OVERVIEW / OUTLINE
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.1, DARK_BLUE)
add_text(slide, "Overview", 0.4, 0.1, 12, 0.9, font_size=32, bold=True,
         color=WHITE, align=PP_ALIGN.LEFT)
add_rect(slide, 0, 1.1, 13.333, 6.4, LIGHT_GRAY)

topics = [
    ("1", "Platelet Biology & Thrombosis Cascade", DARK_BLUE),
    ("2", "Classification of Antiplatelet Drugs", MED_BLUE),
    ("3", "Aspirin (COX Inhibitor) — Mechanism, Dosage, Duration", ACCENT_TEAL),
    ("4", "P2Y12 Inhibitors — Clopidogrel, Prasugrel, Ticagrelor, Cangrelor", ACCENT_GREEN),
    ("5", "GP IIb/IIIa Inhibitors — Abciximab, Eptifibatide, Tirofiban", ACCENT_RED),
    ("6", "Dual Antiplatelet Therapy (DAPT) — Regimens & Duration", MED_BLUE),
    ("7", "Clinical Scenarios: ACS, PCI, STEMI, Stable CAD, Stroke", DARK_BLUE),
    ("8", "Adverse Effects, Contraindications & Drug Interactions", ACCENT_RED),
    ("9", "Special Populations & Perioperative Management", ORANGE),
    ("10", "Current Guidelines Summary (2025 ACC/AHA, 2026 ACC)", ACCENT_TEAL),
]

for i, (num, topic, col) in enumerate(topics):
    row = i % 5
    col_x = 0.3 if i < 5 else 6.8
    y_pos = 1.4 + row * 0.95
    add_rect(slide, col_x, y_pos, 0.55, 0.65, col)
    add_text(slide, num, col_x, y_pos, 0.55, 0.65,
             font_size=18, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
             anchor=MSO_ANCHOR.MIDDLE)
    add_text(slide, topic, col_x + 0.65, y_pos + 0.08, 5.7, 0.55,
             font_size=13.5, bold=False, color=DARK_GRAY, wrap=True)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 3 — PLATELET BIOLOGY & THROMBOSIS
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, DARK_BLUE)
add_text(slide, "Platelet Biology & The Thrombosis Cascade", 0.3, 0.05, 12.5, 0.9,
         font_size=26, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

# Left panel: Normal hemostasis steps
add_rect(slide, 0.25, 1.15, 6.0, 5.9, WHITE)
add_text(slide, "Normal Platelet Activation Steps", 0.35, 1.2, 5.8, 0.4,
         font_size=15, bold=True, color=DARK_BLUE)

steps = [
    ("1. Vascular Injury", "Endothelial damage exposes sub-endothelial collagen and von Willebrand factor (vWF)"),
    ("2. Platelet Adhesion", "Platelets adhere via GPIb receptor binding to vWF; collagen activates GPVI"),
    ("3. Platelet Activation", "ADP released from dense granules → P2Y12 receptor activation; TXA2 synthesis via COX-1"),
    ("4. Shape Change", "Platelets swell, extend pseudopods; intracellular Ca²⁺ rises"),
    ("5. GP IIb/IIIa Activation", "Conformational change exposes fibrinogen-binding site on GP IIb/IIIa receptor"),
    ("6. Platelet Aggregation", "Fibrinogen bridges adjacent platelets → platelet plug forms"),
    ("7. Thrombus Stabilization", "Coagulation cascade generates thrombin → fibrin cross-linking"),
]
for j, (step, desc) in enumerate(steps):
    y0 = 1.68 + j*0.74
    add_rect(slide, 0.3, y0, 0.32, 0.32, MED_BLUE)
    add_text(slide, str(j+1), 0.3, y0, 0.32, 0.32, font_size=11, bold=True,
             color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    add_text(slide, step, 0.68, y0, 1.9, 0.32, font_size=10.5, bold=True, color=DARK_BLUE)
    add_text(slide, desc, 0.68, y0+0.3, 5.4, 0.38, font_size=9.5, color=DARK_GRAY, wrap=True)

# Right panel: Key targets
add_rect(slide, 6.55, 1.15, 6.5, 2.6, RGBColor(0xE8, 0xF4, 0xFF))
add_text(slide, "Key Antiplatelet Drug Targets", 6.65, 1.2, 6.2, 0.38,
         font_size=14, bold=True, color=DARK_BLUE)
targets = [
    ("COX-1 Enzyme", "→ Aspirin inhibits TXA2 synthesis", ACCENT_RED),
    ("P2Y12 ADP Receptor", "→ Thienopyridines, ticagrelor, cangrelor", ACCENT_GREEN),
    ("GP IIb/IIIa Receptor", "→ Abciximab, eptifibatide, tirofiban", MED_BLUE),
    ("PAR-1 Receptor", "→ Vorapaxar (thrombin receptor)", ORANGE),
    ("Phosphodiesterase", "→ Dipyridamole, cilostazol", ACCENT_TEAL),
]
for j, (tgt, detail, col) in enumerate(targets):
    y0 = 1.65 + j*0.42
    add_rect(slide, 6.6, y0+0.02, 0.16, 0.28, col)
    add_text(slide, tgt, 6.85, y0, 2.2, 0.28, font_size=10.5, bold=True, color=col)
    add_text(slide, detail, 9.1, y0, 3.8, 0.28, font_size=10, color=DARK_GRAY)

add_rect(slide, 6.55, 3.85, 6.5, 3.15, RGBColor(0xFD, 0xF2, 0xE4))
add_text(slide, "Clinical Significance of Antiplatelet Therapy", 6.65, 3.9, 6.2, 0.38,
         font_size=13, bold=True, color=ORANGE)
facts = [
    "Platelets cannot synthesize new proteins — COX inhibition by aspirin is permanent for platelet lifespan (~10 days)",
    "ACS events are primarily triggered by plaque rupture + platelet thrombus formation",
    "DAPT reduces major cardiovascular events by 18–30% in ACS vs aspirin alone",
    "Stent thrombosis risk is highest in first 30 days; DAPT duration is critical",
    "Antiplatelet resistance occurs in ~20–25% of patients on clopidogrel (CYP2C19 polymorphism)",
]
for j, fact in enumerate(facts):
    add_text(slide, f"• {fact}", 6.65, 4.35 + j*0.52, 6.2, 0.48,
             font_size=10, color=DARK_GRAY, wrap=True)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 4 — CLASSIFICATION
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, DARK_BLUE)
add_text(slide, "Classification of Antiplatelet Drugs", 0.3, 0.05, 12.5, 0.9,
         font_size=26, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

classes = [
    {
        "class": "I. COX Inhibitors",
        "color": ACCENT_RED,
        "drugs": ["Aspirin (acetylsalicylic acid)"],
        "moa": "Irreversibly acetylates COX-1/COX-2 → ↓ TXA2 → ↓ platelet aggregation & vasoconstriction",
    },
    {
        "class": "II. P2Y12 ADP Receptor Antagonists",
        "color": ACCENT_GREEN,
        "drugs": ["Clopidogrel (Plavix)", "Prasugrel (Effient)", "Ticagrelor (Brilinta)", "Cangrelor (Kengreal)", "Ticlopidine (older)"],
        "moa": "Block ADP-mediated activation of P2Y12 receptor → prevent GP IIb/IIIa activation → ↓ aggregation",
    },
    {
        "class": "III. GP IIb/IIIa Inhibitors",
        "color": MED_BLUE,
        "drugs": ["Abciximab (ReoPro)", "Eptifibatide (Integrilin)", "Tirofiban (Aggrastat)"],
        "moa": "Block final common pathway of platelet aggregation — fibrinogen binding to GP IIb/IIIa receptor",
    },
    {
        "class": "IV. PAR-1 Antagonist",
        "color": ORANGE,
        "drugs": ["Vorapaxar (Zontivity)"],
        "moa": "Blocks protease-activated receptor-1 (PAR-1) — thrombin-mediated platelet activation",
    },
    {
        "class": "V. Phosphodiesterase Inhibitors",
        "color": ACCENT_TEAL,
        "drugs": ["Dipyridamole", "Cilostazol"],
        "moa": "Inhibit PDE → ↑ cAMP → ↓ platelet aggregation; also vasodilatory effects",
    },
]

cols_x = [0.25, 2.95, 5.65, 8.35, 11.05]
for i, cls in enumerate(classes):
    x = cols_x[i]
    w = 2.55
    add_rect(slide, x, 1.1, w, 0.55, cls["color"])
    add_text(slide, cls["class"], x+0.07, 1.12, w-0.12, 0.5,
             font_size=11, bold=True, color=WHITE, wrap=True, align=PP_ALIGN.CENTER,
             anchor=MSO_ANCHOR.MIDDLE)
    y_d = 1.72
    add_rect(slide, x, y_d, w, 0.06, cls["color"])
    add_text(slide, "Drugs:", x+0.07, 1.78, w-0.12, 0.28,
             font_size=10, bold=True, color=cls["color"])
    y_d = 2.06
    for drug in cls["drugs"]:
        add_text(slide, f"• {drug}", x+0.1, y_d, w-0.18, 0.26,
                 font_size=9.5, color=DARK_GRAY, wrap=True)
        y_d += 0.24
    add_rect(slide, x, 4.5, w, 0.06, cls["color"])
    add_text(slide, "Mechanism:", x+0.07, 4.58, w-0.12, 0.28,
             font_size=10, bold=True, color=cls["color"])
    add_text(slide, cls["moa"], x+0.08, 4.87, w-0.15, 1.75,
             font_size=9, color=DARK_GRAY, wrap=True)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 5 — ASPIRIN
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, ACCENT_RED)
add_text(slide, "Aspirin (Acetylsalicylic Acid) — COX Inhibitor", 0.3, 0.05, 12.5, 0.9,
         font_size=26, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

# Left: mechanism image
if os.path.exists(img1_path):
    slide.shapes.add_picture(img1_path, Inches(0.2), Inches(1.1), Inches(3.8), Inches(4.2))
add_text(slide, "Fig: Aspirin irreversibly inhibits COX enzyme\n→ ↓ TXA2 → ↓ platelet reactivity",
         0.2, 5.35, 3.8, 0.7, font_size=9, italic=True, color=MID_GRAY, wrap=True,
         align=PP_ALIGN.CENTER)

# Right: dosing boxes
add_rect(slide, 4.3, 1.1, 8.8, 1.55, RGBColor(0xFF, 0xEB, 0xEB))
add_text(slide, "DOSAGE", 4.4, 1.12, 3, 0.38, font_size=14, bold=True, color=ACCENT_RED)
dosage_rows = [
    ("ACS / Initial (chewable):", "162–325 mg stat", ACCENT_RED),
    ("Maintenance (all indications):", "75–100 mg once daily (lifelong)", DARK_BLUE),
    ("After PCI (with DAPT):", "81 mg daily — do NOT exceed 100 mg with ticagrelor", ACCENT_GREEN),
    ("CABG post-op:", "81–325 mg within 6 hours; continue lifelong", DARK_BLUE),
]
for j, (label, val, col) in enumerate(dosage_rows):
    y0 = 1.55 + j * 0.27
    add_text(slide, label, 4.4, y0, 3.5, 0.26, font_size=10, bold=True, color=DARK_GRAY)
    add_text(slide, val, 7.95, y0, 5.0, 0.26, font_size=10, color=col, bold=True)

# Duration
add_rect(slide, 4.3, 2.75, 8.8, 1.2, RGBColor(0xE8, 0xF8, 0xE8))
add_text(slide, "TREATMENT DURATION", 4.4, 2.78, 5, 0.38, font_size=14, bold=True, color=ACCENT_GREEN)
dur_rows = [
    ("Secondary prevention (ACS, PCI, CABG, stroke):", "LIFELONG"),
    ("Primary prevention (selected high-risk patients):", "Individualized — discuss bleeding vs benefit"),
    ("Primary prevention (low-risk):", "NOT recommended routinely (2018-2022 guidelines)"),
]
for j, (label, val) in enumerate(dur_rows):
    y0 = 3.2 + j * 0.27
    add_text(slide, label, 4.4, y0, 5.5, 0.26, font_size=10, color=DARK_GRAY)
    add_text(slide, val, 9.95, y0, 3.0, 0.26, font_size=10, bold=True, color=ACCENT_GREEN)

# Key facts
add_rect(slide, 4.3, 4.05, 8.8, 2.9, RGBColor(0xEA, 0xF2, 0xFF))
add_text(slide, "KEY PHARMACOLOGICAL FACTS", 4.4, 4.1, 8, 0.35,
         font_size=13, bold=True, color=DARK_BLUE)
facts = [
    "Mechanism: Irreversible acetylation of COX-1 (and COX-2) → ↓ prostaglandins & TXA2",
    "Onset of platelet inhibition: Minutes (blocks within 1 hour of ingestion)",
    "Duration of effect: ~10 days (entire platelet lifespan — platelets cannot regenerate COX)",
    "Plasma half-life: 20 minutes, but platelet effect lasts 10 days",
    "25% reduction in cardiovascular events in secondary prevention (RCT meta-analyses)",
    "Low-dose (81 mg) is as effective as high-dose with fewer GI adverse effects",
    "Main adverse effect: GI bleeding / peptic ulceration; bronchoconstriction in ASA-sensitive asthma",
    "Contraindication: Active peptic ulcer, ASA hypersensitivity, children with viral illness (Reye syndrome)",
]
for j, fact in enumerate(facts):
    add_text(slide, f"• {fact}", 4.4, 4.48 + j * 0.295, 8.5, 0.28,
             font_size=9.8, color=DARK_GRAY, wrap=True)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 6 — P2Y12 INHIBITORS (OVERVIEW + MECHANISM)
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, ACCENT_GREEN)
add_text(slide, "P2Y12 ADP Receptor Inhibitors — Mechanism & Classification", 0.3, 0.05, 12.5, 0.9,
         font_size=24, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

# Image on right
if os.path.exists(img2_path):
    slide.shapes.add_picture(img2_path, Inches(8.7), Inches(1.1), Inches(4.4), Inches(4.0))
add_text(slide, "Fig: P2Y12 inhibitors block ADP-mediated\nGP IIb/IIIa activation",
         8.7, 5.15, 4.4, 0.5, font_size=9, italic=True, color=MID_GRAY,
         align=PP_ALIGN.CENTER, wrap=True)

# Left: mechanism text
add_rect(slide, 0.2, 1.1, 8.3, 1.0, RGBColor(0xE8, 0xF8, 0xE8))
add_text(slide, "Mechanism:", 0.3, 1.12, 1.5, 0.35, font_size=12, bold=True, color=ACCENT_GREEN)
add_text(slide, "Block P2Y12 ADP receptor on platelets → prevent Ca²⁺ influx → prevent GP IIb/IIIa conformational activation → inhibit fibrinogen binding → block platelet aggregation",
         1.85, 1.12, 6.5, 0.85, font_size=11, color=DARK_GRAY, wrap=True)

# Drug comparison table
headers = ["Property", "Clopidogrel", "Prasugrel", "Ticagrelor", "Cangrelor"]
rows = [
    ["Brand name", "Plavix", "Effient", "Brilinta", "Kengreal"],
    ["Drug class", "Thienopyridine", "Thienopyridine", "Cyclopentyl-triazolopyrimidine", "ATP analogue"],
    ["Route", "Oral", "Oral", "Oral", "IV only"],
    ["Prodrug?", "Yes (CYP2C19)", "Yes (CYP3A4/2B6)", "No — active drug", "No — active drug"],
    ["Binding", "Irreversible", "Irreversible", "Reversible", "Reversible"],
    ["Loading dose", "300–600 mg", "60 mg", "180 mg", "30 µg/kg IV bolus"],
    ["Maintenance dose", "75 mg once daily", "10 mg once daily", "90 mg twice daily", "4 µg/kg/min IV infusion"],
    ["Onset", "3–5 days", "2–4 hours", "1–3 hours", "2 minutes (IV)"],
    ["Half-life", "30–60 min (metab)", "~7 hr (active metab)", "7–9 hours", "3–6 minutes"],
    ["Duration of effect", "3–10 days", "7–10 days", "3–5 days", "1–2 hours after stop"],
    ["Stop before surgery", "5 days", "7 days", "5 days", "1 hour"],
]

col_widths = [2.2, 1.55, 1.55, 2.0, 1.8]
col_x = [0.2, 2.45, 4.05, 5.65, 7.7]
header_colors = [DARK_BLUE, ACCENT_GREEN, ACCENT_GREEN, ACCENT_GREEN, ACCENT_GREEN]

y_table = 2.2
row_h = 0.38
add_rect(slide, 0.2, y_table, 9.35, row_h, DARK_BLUE)
for ci, (hdr, cx, cw) in enumerate(zip(headers, col_x, col_widths)):
    add_text(slide, hdr, cx+0.04, y_table+0.02, cw-0.06, row_h-0.04,
             font_size=10, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
             anchor=MSO_ANCHOR.MIDDLE)

for ri, row in enumerate(rows):
    y_row = y_table + (ri+1)*row_h
    bg = WHITE if ri % 2 == 0 else RGBColor(0xF0, 0xF8, 0xF0)
    add_rect(slide, 0.2, y_row, 9.35, row_h, bg)
    # highlight row
    for ci, (val, cx, cw) in enumerate(zip(row, col_x, col_widths)):
        is_bold = ci == 0
        col = DARK_BLUE if ci == 0 else DARK_GRAY
        add_text(slide, val, cx+0.04, y_row+0.02, cw-0.06, row_h-0.04,
                 font_size=9.2, bold=is_bold, color=col,
                 align=PP_ALIGN.LEFT if ci == 0 else PP_ALIGN.CENTER,
                 anchor=MSO_ANCHOR.MIDDLE, wrap=True)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 7 — CLOPIDOGREL & PRASUGREL detail
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, ACCENT_GREEN)
add_text(slide, "Clopidogrel & Prasugrel — Detailed Profile", 0.3, 0.05, 12.5, 0.9,
         font_size=26, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

# Clopidogrel
add_rect(slide, 0.2, 1.1, 6.25, 6.15, WHITE)
add_rect(slide, 0.2, 1.1, 6.25, 0.5, ACCENT_GREEN)
add_text(slide, "CLOPIDOGREL (Plavix)", 0.3, 1.12, 6.0, 0.45,
         font_size=16, bold=True, color=WHITE)

clop_sections = [
    ("Mechanism", "Prodrug requiring CYP2C19 hepatic activation. Active metabolite irreversibly blocks P2Y12 ADP receptor. Genetic polymorphism (poor metabolizers ~25–35%) reduces efficacy."),
    ("Indications", "ACS (UA/NSTEMI/STEMI), PCI (with or without stenting), peripheral artery disease, ischemic stroke/TIA prevention"),
    ("Dosage", "• Loading: 300–600 mg (600 mg preferred in PCI)\n• Maintenance: 75 mg once daily"),
    ("DAPT Duration", "• Bare metal stent (BMS): minimum 30 days\n• Drug-eluting stent (DES): 6–12 months\n• Medical ACS (no stent): 12 months\n• High-bleeding risk: may shorten to 3–6 months"),
    ("Key Evidence", "CURE trial: clopidogrel + aspirin ↓ composite CVD death/MI/stroke by 20% in NSTEMI\nCLEAR PLATE, CAPRIE: efficacy in PAD and stroke"),
    ("Adverse Effects", "Bleeding (GI, intracranial), thrombotic thrombocytopenic purpura (rare), neutropenia\nDrug interaction: PPIs (omeprazole) inhibit CYP2C19 → ↓ efficacy"),
    ("Contraindications", "Active pathological bleeding, history of intracranial hemorrhage"),
]
y0 = 1.68
for section, content in clop_sections:
    add_text(slide, section + ":", 0.3, y0, 1.5, 0.28, font_size=10, bold=True, color=ACCENT_GREEN)
    add_text(slide, content, 1.85, y0, 4.45, 0.65, font_size=9.3, color=DARK_GRAY, wrap=True)
    y0 += 0.78

# Prasugrel
add_rect(slide, 6.85, 1.1, 6.25, 6.15, WHITE)
add_rect(slide, 6.85, 1.1, 6.25, 0.5, ACCENT_TEAL)
add_text(slide, "PRASUGREL (Effient)", 6.95, 1.12, 6.0, 0.45,
         font_size=16, bold=True, color=WHITE)

pras_sections = [
    ("Mechanism", "Prodrug requiring CYP3A4/2B6 activation. Greater bioavailability of active metabolite than clopidogrel. Faster onset (2–4 hr) and greater platelet inhibition. Irreversible binding."),
    ("Indications", "ACS (UA/NSTEMI/STEMI) managed with PCI — use ONLY after coronary anatomy is known and PCI is planned"),
    ("Dosage", "• Loading: 60 mg (only at time of PCI)\n• Maintenance: 10 mg once daily\n• Reduced dose (5 mg): body weight <60 kg or age ≥75 yr"),
    ("DAPT Duration", "• 12 months after ACS/PCI with DES\n• Minimum 30 days after BMS\n• Avoid in prior stroke/TIA (contraindicated)"),
    ("Key Evidence", "TRITON-TIMI 38: prasugrel vs clopidogrel in PCI — ↓ MI 24%, stent thrombosis 52%, but ↑ TIMI major bleeding 32%\nHigh-risk patients (diabetes, prior MI) benefit most"),
    ("Adverse Effects", "Bleeding risk higher than clopidogrel (TIMI major bleed 2.4% vs 1.8%)\nFatal bleeding 0.4% vs 0.1%; CABG-related bleeding significantly higher"),
    ("Contraindications", "Prior stroke/TIA; Active pathological bleeding; Age <18; Use caution: age ≥75, weight <60 kg"),
]
y0 = 1.68
for section, content in pras_sections:
    add_text(slide, section + ":", 6.95, y0, 1.5, 0.28, font_size=10, bold=True, color=ACCENT_TEAL)
    add_text(slide, content, 8.5, y0, 4.45, 0.65, font_size=9.3, color=DARK_GRAY, wrap=True)
    y0 += 0.78

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 8 — TICAGRELOR & CANGRELOR
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, DARK_BLUE)
add_text(slide, "Ticagrelor & Cangrelor — Next-Generation P2Y12 Inhibitors", 0.3, 0.05, 12.5, 0.9,
         font_size=24, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

# Ticagrelor
add_rect(slide, 0.2, 1.1, 6.25, 6.15, WHITE)
add_rect(slide, 0.2, 1.1, 6.25, 0.5, MED_BLUE)
add_text(slide, "TICAGRELOR (Brilinta)", 0.3, 1.12, 6.0, 0.45,
         font_size=16, bold=True, color=WHITE)
tica_sections = [
    ("Mechanism", "NOT a prodrug. Direct, reversible P2Y12 inhibitor. Does not require metabolic activation. Binds different site than ADP on P2Y12 (allosteric). Faster and more consistent platelet inhibition than clopidogrel."),
    ("Indications", "ACS (UA/NSTEMI/STEMI — with or without PCI), secondary prevention in patients with prior MI at high risk"),
    ("Dosage", "• Loading: 180 mg\n• Maintenance: 90 mg twice daily (12 months after ACS)\n• Extended low-dose: 60 mg twice daily (>12 months post-MI)\n• Aspirin maintenance must be ≤100 mg/day with ticagrelor"),
    ("DAPT Duration", "• Standard: 12 months post-ACS\n• Extended: 60 mg BID beyond 12 months if no excess bleeding\n• High bleeding risk: as short as 1–3 months then ticagrelor monotherapy (2025 ACC/AHA Class I)"),
    ("Key Evidence", "PLATO trial: ticagrelor vs clopidogrel in ACS — ↓ CV death/MI/stroke 16%; ↓ CV mortality 21%; ↓ all-cause mortality 22%\nPEGASUS trial: extended 60 mg BID post-MI ↓ major events"),
    ("Adverse Effects", "Dyspnea (14%) — not bronchospasm; Bradycardia/pauses (asymptomatic); Bleeding; Elevated creatinine/uric acid\nContraindicated: intracranial hemorrhage, active bleed, severe hepatic impairment"),
]
y0 = 1.68
for section, content in tica_sections:
    add_text(slide, section + ":", 0.3, y0, 1.5, 0.28, font_size=10, bold=True, color=MED_BLUE)
    add_text(slide, content, 1.85, y0, 4.45, 0.78, font_size=9.3, color=DARK_GRAY, wrap=True)
    y0 += 0.88

# Cangrelor
add_rect(slide, 6.85, 1.1, 6.25, 6.15, WHITE)
add_rect(slide, 6.85, 1.1, 6.25, 0.5, ORANGE)
add_text(slide, "CANGRELOR (Kengreal)", 6.95, 1.12, 6.0, 0.45,
         font_size=16, bold=True, color=WHITE)
cang_sections = [
    ("Mechanism", "Direct-acting IV P2Y12 inhibitor (ATP analogue). Reversible binding. Onset within 2 minutes (IV). No hepatic metabolism — no CYP dependence. Predictable antiplatelet effect."),
    ("Indications", "Adjunct during PCI in patients not pre-treated with oral P2Y12 inhibitor; Bridging therapy for patients on DAPT requiring non-cardiac surgery"),
    ("Dosage", "• Bolus: 30 µg/kg IV\n• Infusion: 4 µg/kg/min IV during PCI (at least 2 hrs or duration of procedure)\n• Transition: Start oral P2Y12 30 min after infusion stopped"),
    ("Duration", "Short-term use only — during PCI procedure\nInfusion duration: 2 hours minimum\nPlatelet function normalizes 1–2 hours after stopping"),
    ("Key Evidence", "CHAMPION trials: cangrelor vs clopidogrel/placebo — ↓ periprocedural MI, stent thrombosis; CHAMPION PHOENIX: ↓ stent thrombosis 41%"),
    ("Advantages", "Unique reversible IV formulation; ideal for patients who cannot take oral medications; safe bridge before surgery\nExpense and modest evidence limit routine use"),
]
y0 = 1.68
for section, content in cang_sections:
    add_text(slide, section + ":", 6.95, y0, 1.5, 0.28, font_size=10, bold=True, color=ORANGE)
    add_text(slide, content, 8.5, y0, 4.45, 0.78, font_size=9.3, color=DARK_GRAY, wrap=True)
    y0 += 0.88

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 9 — GP IIb/IIIa INHIBITORS
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, ACCENT_RED)
add_text(slide, "GP IIb/IIIa Receptor Inhibitors", 0.3, 0.05, 12.5, 0.9,
         font_size=28, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

add_rect(slide, 0.2, 1.1, 12.9, 0.75, RGBColor(0xFF, 0xEB, 0xEB))
add_text(slide, "Mechanism (All 3 agents):", 0.3, 1.12, 2.8, 0.35, font_size=12, bold=True, color=ACCENT_RED)
add_text(slide, "Block the GP IIb/IIIa receptor (αIIbβ3 integrin) — the final common pathway of platelet aggregation. Prevent fibrinogen (and vWF) from binding to activated platelets. Administered IV only. Used primarily as adjunct to PCI.",
         3.15, 1.12, 9.7, 0.7, font_size=10.5, color=DARK_GRAY, wrap=True)

agents = [
    {
        "name": "ABCIXIMAB (ReoPro)",
        "color": ACCENT_RED,
        "type": "Chimeric monoclonal antibody Fab fragment",
        "binding": "Noncompetitive, irreversible (tight)",
        "bolus": "0.25 mg/kg IV bolus",
        "infusion": "0.125 µg/kg/min IV (max 10 µg/min) × 12 hours",
        "onset": "Immediate",
        "half_life": "Plasma: 30 min; Platelet: 24–48 hours",
        "recovery": "48 hours (platelet transfusion can reverse)",
        "indication": "High-risk PCI (unstable angina, STEMI), adjunct to PCI",
        "notes": "Not for use if PCI not planned. Most potent GP IIb/IIIa blocker. Risk of thrombocytopenia (HIT-like).",
    },
    {
        "name": "EPTIFIBATIDE (Integrilin)",
        "color": MED_BLUE,
        "type": "Cyclic heptapeptide (KGD sequence)",
        "binding": "Competitive, reversible",
        "bolus": "180 µg/kg IV bolus (repeat in 10 min for PCI)",
        "infusion": "2 µg/kg/min IV × 18–24 hrs (reduce in renal impairment)",
        "onset": "Immediate",
        "half_life": "2.5 hours",
        "recovery": "4–8 hours",
        "indication": "ACS (NSTEMI/UA) with or without PCI; PCI adjunct",
        "notes": "Most consistent platelet inhibition; shortest on-time; dose-reduce in CrCl <50 mL/min. Contraindicated in severe renal failure.",
    },
    {
        "name": "TIROFIBAN (Aggrastat)",
        "color": ACCENT_TEAL,
        "type": "Non-peptide peptidomimetic",
        "binding": "Competitive, reversible",
        "bolus": "25 µg/kg IV bolus over 3 min",
        "infusion": "0.15 µg/kg/min IV × 18–24 hours",
        "onset": "Immediate",
        "half_life": "2 hours",
        "recovery": "4–8 hours",
        "indication": "ACS (NSTEMI/UA), PCI adjunct; peripheral vascular intervention",
        "notes": "Similar to eptifibatide; dose-reduce in renal impairment. Less expensive than abciximab.",
    },
]

col_x = [0.2, 4.5, 8.8]
for i, agent in enumerate(agents):
    x = col_x[i]
    w = 4.1
    add_rect(slide, x, 1.95, w, 0.42, agent["color"])
    add_text(slide, agent["name"], x+0.08, 1.97, w-0.14, 0.38,
             font_size=13, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
             anchor=MSO_ANCHOR.MIDDLE)

    rows_data = [
        ("Type:", agent["type"]),
        ("Binding:", agent["binding"]),
        ("Bolus:", agent["bolus"]),
        ("Infusion:", agent["infusion"]),
        ("Half-life:", agent["half_life"]),
        ("Recovery:", agent["recovery"]),
        ("Indication:", agent["indication"]),
    ]
    y0 = 2.43
    for label, val in rows_data:
        add_text(slide, label, x+0.1, y0, 1.1, 0.3, font_size=9.5, bold=True, color=agent["color"])
        add_text(slide, val, x+1.22, y0, w-1.32, 0.45, font_size=9.3, color=DARK_GRAY, wrap=True)
        y0 += 0.42

    add_rect(slide, x, y0, w, 0.06, agent["color"])
    add_text(slide, "Notes: " + agent["notes"], x+0.1, y0+0.08, w-0.15, 0.75,
             font_size=9, italic=True, color=DARK_GRAY, wrap=True)

# Comparison note
add_rect(slide, 0.2, 6.8, 12.9, 0.45, RGBColor(0xFD, 0xF2, 0xE4))
add_text(slide, "Note: All GP IIb/IIIa inhibitors ↓ death or MI in ACS undergoing PCI. Eptifibatide has most consistent inhibition. Abciximab reversed by platelet transfusion; eptifibatide/tirofiban are not reversible by transfusion. Use with aspirin + heparin.",
         0.3, 6.83, 12.7, 0.4, font_size=9.3, color=DARK_GRAY, wrap=True)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 10 — DAPT REGIMENS & DURATION
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, MED_BLUE)
add_text(slide, "Dual Antiplatelet Therapy (DAPT) — Regimens & Duration", 0.3, 0.05, 12.5, 0.9,
         font_size=24, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

add_rect(slide, 0.2, 1.1, 12.9, 0.5, RGBColor(0xD6, 0xE8, 0xF7))
add_text(slide, "DAPT = Aspirin (81 mg/day) + P2Y12 inhibitor (clopidogrel / ticagrelor / prasugrel)",
         0.3, 1.12, 12.6, 0.45, font_size=13, bold=True, color=DARK_BLUE,
         align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)

# Table
headers2 = ["Clinical Scenario", "P2Y12 of Choice", "Loading Dose", "Maintenance", "Duration", "Notes"]
col_widths2 = [2.4, 1.9, 1.7, 1.7, 2.0, 2.9]
col_x2 = [0.2, 2.65, 4.6, 6.35, 8.1, 10.15]

table_rows = [
    ["STEMI — Primary PCI", "Ticagrelor or Prasugrel (preferred)\nor Clopidogrel", "180 mg / 60 mg\nor 600 mg", "90 mg BID / 10 mg OD\nor 75 mg OD", "12 months minimum\n(extend if low bleed risk)", "Preferred: ticagrelor > prasugrel > clopidogrel (2025 ACC/AHA)"],
    ["NSTEMI / UA — Invasive", "Ticagrelor (preferred)\nor Prasugrel post-PCI\nor Clopidogrel", "180 mg\n60 mg (after PCI)\n300–600 mg", "90 mg BID\n10 mg OD\n75 mg OD", "12 months", "Prasugrel only after coronary anatomy known; avoid if prior stroke/TIA"],
    ["NSTEMI / UA — Conservative", "Ticagrelor or Clopidogrel", "180 mg\nor 300–600 mg", "90 mg BID\nor 75 mg OD", "12 months", "Prasugrel NOT recommended in this strategy"],
    ["PCI — Drug-Eluting Stent (DES)", "Clopidogrel, Ticagrelor, or Prasugrel", "Per drug above", "Per drug above", "Minimum 6 months\n(preferred 12 months)", "May extend to 30 months if low bleed risk (DAPT trial)"],
    ["PCI — Bare Metal Stent (BMS)", "Clopidogrel (preferred)", "300–600 mg", "75 mg OD", "Minimum 30 days\n(up to 12 months)", "BMS use now uncommon"],
    ["Stable CAD / Chronic Coronary Syndrome", "Clopidogrel (if needed)", "300 mg", "75 mg OD", "Not routinely recommended\nAspirin monotherapy preferred", "DAPT may be extended in selected high-risk post-ACS patients"],
    ["High Bleeding Risk (HBR)", "Clopidogrel preferred\n(or ticagrelor)", "300 mg\nor 180 mg", "75 mg OD\nor 90 mg BID", "1–3 months, then\nmonotherapy (P2Y12 preferred)", "2025 ACC/AHA: Ticagrelor monotherapy ≥1 mo post-PCI (Class I)"],
    ["Post-Fibrinolysis (STEMI)", "Clopidogrel", "300 mg (<75 yr)\nor 0 (≥75 yr)", "75 mg OD", "12 months (minimum 14 days)", "Do NOT use prasugrel/ticagrelor within 24 hr of fibrinolysis"],
]

y_table2 = 1.68
hdr_h = 0.36
row_h2 = 0.63
add_rect(slide, 0.2, y_table2, 12.9, hdr_h, DARK_BLUE)
for ci, (hdr, cx, cw) in enumerate(zip(headers2, col_x2, col_widths2)):
    add_text(slide, hdr, cx+0.04, y_table2+0.02, cw-0.06, hdr_h-0.04,
             font_size=10, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
             anchor=MSO_ANCHOR.MIDDLE)

for ri, row in enumerate(table_rows):
    y_row = y_table2 + hdr_h + ri*row_h2
    bg = WHITE if ri % 2 == 0 else RGBColor(0xEA, 0xF2, 0xFF)
    add_rect(slide, 0.2, y_row, 12.9, row_h2, bg)
    for ci, (val, cx, cw) in enumerate(zip(row, col_x2, col_widths2)):
        is_bold = ci == 0
        col = DARK_BLUE if ci == 0 else (ACCENT_RED if ci == 4 else DARK_GRAY)
        add_text(slide, val, cx+0.04, y_row+0.02, cw-0.06, row_h2-0.04,
                 font_size=8.8, bold=is_bold, color=col,
                 align=PP_ALIGN.LEFT, anchor=MSO_ANCHOR.MIDDLE, wrap=True)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 11 — CLINICAL SCENARIOS (ACS, STEMI, PCI)
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, DARK_BLUE)
add_text(slide, "Clinical Scenarios: Step-by-Step Antiplatelet Management", 0.3, 0.05, 12.5, 0.9,
         font_size=24, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

scenarios = [
    {
        "title": "STEMI — Primary PCI",
        "color": ACCENT_RED,
        "steps": [
            "STAT: Aspirin 325 mg chewable (at first medical contact)",
            "Loading P2Y12: Ticagrelor 180 mg OR Prasugrel 60 mg (or Clopidogrel 600 mg if above unavailable)",
            "Optional: Cangrelor IV bolus 30 µg/kg if patient cannot take oral meds",
            "Consider: GP IIb/IIIa inhibitor (abciximab/eptifibatide) if high thrombus burden",
            "Post-PCI: Aspirin 81 mg + Ticagrelor 90 mg BID (or prasugrel 10 mg OD) × 12 months",
            "After 12 months: Aspirin 81 mg indefinitely; consider ticagrelor 60 mg BID if high ischemic risk",
        ]
    },
    {
        "title": "NSTEMI / UA — Invasive Strategy",
        "color": ACCENT_GREEN,
        "steps": [
            "STAT: Aspirin 162–325 mg (chewable)",
            "Add P2Y12: Ticagrelor 180 mg LD (preferred) OR Clopidogrel 300–600 mg LD",
            "Hold prasugrel until coronary anatomy is known (avoid before angiography)",
            "If PCI performed: may switch to prasugrel 60 mg LD at time of PCI",
            "GP IIb/IIIa inhibitor (eptifibatide/tirofiban): consider if high-risk ACS, not pre-treated",
            "Duration: Aspirin 81 mg lifelong + P2Y12 × 12 months",
        ]
    },
    {
        "title": "Stable Angina / Chronic Coronary Syndrome",
        "color": MED_BLUE,
        "steps": [
            "Aspirin 81 mg daily — long-term (unless contraindicated)",
            "DAPT not routinely indicated for stable CAD alone",
            "After elective PCI: Aspirin + Clopidogrel 75 mg OD × 6 months (DES) or 1 month (BMS)",
            "High-risk post-MI (>12 months): consider adding ticagrelor 60 mg BID to aspirin",
            "Clopidogrel as monotherapy: if aspirin intolerant",
        ]
    },
    {
        "title": "Ischemic Stroke / TIA",
        "color": ORANGE,
        "steps": [
            "Aspirin 160–325 mg within 24–48 hours of ischemic stroke",
            "Short-term DAPT: Aspirin + Clopidogrel × 21 days (minor stroke/TIA — POINT/CHANCE trials)",
            "Long-term: Aspirin 81 mg OR Clopidogrel 75 mg monotherapy (equivalent for stroke prevention)",
            "Ticlopidine: alternative if ASA intolerant (monitor CBC for neutropenia/TTP)",
            "Avoid ticagrelor/prasugrel in prior hemorrhagic stroke",
        ]
    },
]

scen_x = [0.2, 6.85]
scen_y = [1.1, 1.1, 4.55, 4.55]
scen_pos = [(0.2, 1.1), (6.85, 1.1), (0.2, 4.55), (6.85, 4.55)]

for i, (scenario, (x, y)) in enumerate(zip(scenarios, scen_pos)):
    w = 6.2
    h = 3.25
    add_rect(slide, x, y, w, 0.42, scenario["color"])
    add_text(slide, scenario["title"], x+0.1, y+0.03, w-0.15, 0.37,
             font_size=13, bold=True, color=WHITE)
    add_rect(slide, x, y+0.42, w, h-0.42, WHITE)
    for j, step in enumerate(scenario["steps"]):
        add_rect(slide, x+0.12, y+0.5+j*0.44, 0.3, 0.28, scenario["color"])
        add_text(slide, str(j+1), x+0.12, y+0.5+j*0.44, 0.3, 0.28,
                 font_size=9, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
                 anchor=MSO_ANCHOR.MIDDLE)
        add_text(slide, step, x+0.5, y+0.5+j*0.44, w-0.6, 0.42,
                 font_size=9.2, color=DARK_GRAY, wrap=True)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 12 — ADVERSE EFFECTS & CONTRAINDICATIONS
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, ACCENT_RED)
add_text(slide, "Adverse Effects, Contraindications & Drug Interactions", 0.3, 0.05, 12.5, 0.9,
         font_size=24, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

# Main bleeding risks
add_rect(slide, 0.2, 1.1, 8.8, 3.4, WHITE)
add_rect(slide, 0.2, 1.1, 8.8, 0.4, ACCENT_RED)
add_text(slide, "BLEEDING RISKS — All Antiplatelet Agents", 0.3, 1.12, 8.5, 0.36,
         font_size=13, bold=True, color=WHITE)
bleed_data = [
    ("Drug", "Major Bleeding Rate", "Key Concern", "Reversal Agent"),
    ("Aspirin 75–100 mg/day", "~1–3%/year", "GI bleeding, hemorrhagic stroke", "Platelet transfusion; desmopressin"),
    ("Clopidogrel + ASA (DAPT)", "~2–4%/year", "GI bleed, ICH; higher post-surgery", "Platelet transfusion"),
    ("Ticagrelor + ASA", "4.5% vs 3.8% (vs clopidogrel)", "CABG bleed; dyspnea (not bleed)", "No specific antidote; platelet transfusion"),
    ("Prasugrel + ASA", "2.4% vs 1.8% (vs clopidogrel)", "CABG-related fatal bleed; age >75 high risk", "Platelet transfusion"),
    ("GP IIb/IIIa inhibitors", "~6–8% with PCI adjuncts", "Access-site bleed, ICH; thrombocytopenia", "Abciximab: platelet transfusion reverses"),
]
hdr_cols = [2.0, 2.2, 2.7, 1.75]
hdr_x = [0.22, 2.25, 4.5, 7.25]
y_tbl = 1.55
add_rect(slide, 0.2, y_tbl, 8.8, 0.3, DARK_BLUE)
for ci, (hdr, cx, cw) in enumerate(zip(bleed_data[0], hdr_x, hdr_cols)):
    add_text(slide, hdr, cx+0.03, y_tbl+0.01, cw-0.05, 0.27,
             font_size=9.5, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
             anchor=MSO_ANCHOR.MIDDLE)
for ri, row in enumerate(bleed_data[1:]):
    y_row = y_tbl + 0.3 + ri * 0.52
    bg = WHITE if ri % 2 == 0 else RGBColor(0xFF, 0xF0, 0xF0)
    add_rect(slide, 0.2, y_row, 8.8, 0.52, bg)
    for ci, (val, cx, cw) in enumerate(zip(row, hdr_x, hdr_cols)):
        col = ACCENT_RED if ci == 1 else DARK_GRAY
        add_text(slide, val, cx+0.03, y_row+0.02, cw-0.05, 0.48,
                 font_size=9, color=col, bold=(ci == 0), wrap=True,
                 anchor=MSO_ANCHOR.MIDDLE)

# Right side
add_rect(slide, 9.25, 1.1, 3.85, 3.4, RGBColor(0xFF, 0xF0, 0xF0))
add_text(slide, "CONTRAINDICATIONS", 9.35, 1.12, 3.6, 0.35,
         font_size=12, bold=True, color=ACCENT_RED)
contras = [
    "Active pathological bleeding (all agents)",
    "Intracranial hemorrhage — all agents",
    "Aspirin: peptic ulcer disease, ASA hypersensitivity, Reye syndrome (pediatrics)",
    "Prasugrel: prior stroke / TIA (absolute contraindication)",
    "Ticagrelor: severe hepatic impairment, strong CYP3A4 inducers",
    "GP IIb/IIIa inhibitors: severe hypertension (>200/110), major surgery in 6 weeks",
    "Thrombocytopenia <100,000/µL (use caution)",
]
for j, c in enumerate(contras):
    add_text(slide, f"• {c}", 9.35, 1.52 + j*0.42, 3.65, 0.4,
             font_size=9, color=DARK_GRAY, wrap=True)

# Drug interactions
add_rect(slide, 0.2, 4.6, 12.9, 2.7, WHITE)
add_rect(slide, 0.2, 4.6, 12.9, 0.35, DARK_BLUE)
add_text(slide, "KEY DRUG INTERACTIONS", 0.3, 4.62, 12.6, 0.3,
         font_size=12, bold=True, color=WHITE)
interactions = [
    ("Clopidogrel + Omeprazole/Esomeprazole", "CYP2C19 inhibition → ↓ clopidogrel activation → ↓ antiplatelet effect. Use pantoprazole instead.", AMBER),
    ("Clopidogrel + Fluconazole/Voriconazole", "Strong CYP2C19 inhibitors → ↓ clopidogrel efficacy", AMBER),
    ("Ticagrelor + Strong CYP3A4 inducers (rifampin, carbamazepine)", "↓ Ticagrelor levels → ↓ effect", ACCENT_RED),
    ("Ticagrelor + Simvastatin/Lovastatin (>40 mg)", "CYP3A4 competition → ↑ statin levels → myopathy risk", ORANGE),
    ("Aspirin + NSAIDs (ibuprofen, naproxen)", "NSAIDs compete for COX-1 binding → block aspirin's antiplatelet effect if NSAID taken first", ACCENT_RED),
    ("Antiplatelet + Anticoagulant (warfarin/NOAC)", "Triple therapy → significantly ↑ bleeding risk. Minimize duration; use PPI gastroprotection.", ACCENT_RED),
    ("Aspirin + SSRIs", "SSRIs inhibit platelet serotonin uptake → additive antiplatelet effect → ↑ GI bleeding risk", AMBER),
]
col_x_int = [0.25, 4.4, 9.5]
col_w_int = [4.1, 5.05, 3.7]
for j, (drug, effect, col) in enumerate(interactions):
    ri = j % 4
    ci = j // 4
    if ci < 2:
        y0 = 5.02 + ri * 0.53
        xi = col_x_int[ci] if ci == 0 else 4.5
        wi = col_w_int[ci] if ci == 0 else 8.55
    else:
        break
    add_rect(slide, xi+0.05, y0+0.03, 0.18, 0.22, col)
    add_text(slide, drug, xi+0.28, y0, 3.0 if ci == 0 else 2.8, 0.26,
             font_size=9, bold=True, color=DARK_GRAY)
    add_text(slide, effect, xi+0.28, y0+0.26, 3.9 if ci == 0 else 8.0, 0.24,
             font_size=8.8, color=DARK_GRAY, wrap=True)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 13 — SPECIAL POPULATIONS & PERIOPERATIVE
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, ORANGE)
add_text(slide, "Special Populations & Perioperative Antiplatelet Management", 0.3, 0.05, 12.5, 0.9,
         font_size=22, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

populations = [
    {
        "title": "Elderly (Age ≥75 years)",
        "color": ORANGE,
        "points": [
            "Prasugrel: avoid or use reduced dose (5 mg/day). Higher fatal bleeding risk (TRITON-TIMI 38).",
            "Ticagrelor: use with caution — dyspnea and bleeding more common.",
            "Aspirin 81 mg remains standard for secondary prevention.",
            "Consider bleeding risk tools (PRECISE-DAPT, HBR criteria) to guide duration.",
            "Shorter DAPT duration (3–6 months) may be appropriate with drug-coated balloon / newer stents.",
        ]
    },
    {
        "title": "Low Body Weight (<60 kg)",
        "color": AMBER,
        "points": [
            "Prasugrel: reduce to 5 mg/day (standard 10 mg has excess bleeding).",
            "Ticagrelor and clopidogrel: standard doses — weight does not alter dosing.",
            "GP IIb/IIIa: weight-based dosing critical — overdosing increases bleed risk.",
        ]
    },
    {
        "title": "Renal Impairment (CKD)",
        "color": MED_BLUE,
        "points": [
            "Aspirin: use with caution in severe CKD (platelet dysfunction already present).",
            "Clopidogrel/Ticagrelor: no dose adjustment needed.",
            "Eptifibatide: dose-reduce if CrCl 10–49 mL/min (1 µg/kg/min); contraindicated if CrCl <10.",
            "Tirofiban: dose-reduce in CrCl <30 mL/min.",
            "Abciximab: no renal adjustment required.",
            "NICE guidelines: antiplatelet agents recommended for secondary CVD prevention in CKD.",
        ]
    },
    {
        "title": "Perioperative Management",
        "color": DARK_BLUE,
        "points": [
            "ASPIRIN: Continue through most non-cardiac surgery (benefit > bleed risk). STOP only for neurosurgery, prostate surgery, or highly vascular procedures.",
            "Clopidogrel: Stop 5 days before elective surgery (ACC/AHA 2024).",
            "Ticagrelor: Stop 5 days before surgery.",
            "Prasugrel: Stop 7 days before surgery (greater platelet inhibition).",
            "Cangrelor: Stop 1–2 hours before surgery — ideal bridging agent.",
            "Post-stent surgery timing: defer elective surgery ≥6 months after PCI for stable CAD; ≥12 months after ACS-PCI.",
            "If urgent surgery after stent: proceed with DAPT if bleeding controllable; otherwise balance with surgeon.",
        ]
    },
    {
        "title": "Pregnancy",
        "color": ACCENT_TEAL,
        "points": [
            "Low-dose aspirin (75–150 mg): indicated for pre-eclampsia prevention in high-risk pregnancy.",
            "Clopidogrel, prasugrel, ticagrelor: insufficient safety data; avoid in pregnancy except life-threatening ACS.",
            "GP IIb/IIIa inhibitors: used in life-threatening ACS only (category C).",
        ]
    },
    {
        "title": "Hepatic Impairment",
        "color": ACCENT_RED,
        "points": [
            "Clopidogrel/Prasugrel: reduced efficacy in severe liver disease (↓ prodrug activation via CYP).",
            "Ticagrelor: contraindicated in severe hepatic impairment.",
            "Aspirin: use with caution in liver disease (risk of GI bleeding and coagulopathy).",
        ]
    },
]

positions = [(0.2, 1.1), (0.2, 3.05), (4.5, 1.1), (4.5, 3.7), (9.0, 1.1), (9.0, 4.2)]
sizes = [(4.1, 1.85), (4.1, 1.75), (4.3, 2.45), (4.3, 3.55), (4.1, 2.9), (4.1, 2.95)]

for (x, y), (w, h), pop in zip(positions, sizes, populations):
    add_rect(slide, x, y, w, 0.38, pop["color"])
    add_text(slide, pop["title"], x+0.08, y+0.02, w-0.12, 0.34,
             font_size=11.5, bold=True, color=WHITE)
    add_rect(slide, x, y+0.38, w, h-0.38, WHITE)
    for j, pt in enumerate(pop["points"]):
        add_text(slide, f"• {pt}", x+0.1, y+0.42+j*((h-0.42)/len(pop["points"])),
                 w-0.18, (h-0.42)/len(pop["points"])+0.02,
                 font_size=9, color=DARK_GRAY, wrap=True)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 14 — CURRENT GUIDELINES SUMMARY
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, ACCENT_TEAL)
add_text(slide, "Current Guidelines Summary — 2025 ACC/AHA & 2026 ACC Scientific Statement", 0.3, 0.05, 12.5, 0.9,
         font_size=20, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

guideline_sections = [
    {
        "title": "2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS Guidelines",
        "color": MED_BLUE,
        "points": [
            "Class I: Loading dose aspirin + P2Y12 inhibitor for ALL ACS patients (no contraindication)",
            "Class I: Ticagrelor or Prasugrel preferred over clopidogrel for NSTE-ACS",
            "Class I: DAPT for at least 12 months post-ACS; transition to ticagrelor 60 mg BID if extended",
            "Class I: Ticagrelor monotherapy ≥1 month post-PCI in ACS who tolerated DAPT well",
            "If triple therapy needed (OAC + DAPT): stop aspirin after 1–4 weeks, continue OAC + P2Y12",
            "DAPT de-escalation from prasugrel/ticagrelor to clopidogrel: may be guided by platelet function/genotyping",
        ]
    },
    {
        "title": "2023 AHA/ACC Chronic Coronary Disease (CCD) Guidelines",
        "color": ACCENT_GREEN,
        "points": [
            "Aspirin 81 mg daily — standard for stable CAD / post-MI secondary prevention",
            "DAPT for elective PCI with DES: 6 months minimum; may extend in low-bleed, high-ischemic risk",
            "Ticagrelor 60 mg BID added to aspirin: for high-risk post-MI patients >12 months out (Class IIb)",
            "Clopidogrel monotherapy: consider in patients intolerant or contraindicated to aspirin",
            "Primary prevention: DAPT NOT recommended; individualize aspirin use",
        ]
    },
    {
        "title": "2023/2024 ESC Guidelines (ACS & Chronic Coronary Syndromes)",
        "color": ORANGE,
        "points": [
            "ESC ACS: Prasugrel preferred over ticagrelor post-PCI (ISAR-REACT 5 evidence)",
            "P2Y12 monotherapy (without aspirin) after 3–6 months of DAPT: Class IIa, Level A",
            "High bleeding risk (HBR): DAPT for 1 month, then P2Y12 monotherapy",
            "Deescalation strategies (guided or unguided): acceptable alternatives to standard DAPT",
            "ESC CCS 2024: Aspirin monotherapy for stable CAD; P2Y12 inhibitor if aspirin intolerant",
        ]
    },
    {
        "title": "2026 ACC Scientific Statement — Antiplatelet Therapy in ASCVD",
        "color": ACCENT_RED,
        "points": [
            "Comprehensive framework across entire ASCVD spectrum",
            "Three DAPT strategies post-ACS: default (12 months), bleeding-reduction, high-bleed-risk options",
            "Perioperative: defer elective surgery ≥6 months post-PCI (CCS); ≥12 months post-PCI (ACS)",
            "Bioprosthetic valves: single antiplatelet therapy (low-dose aspirin) long-term",
            "All guidelines converge on: DAPT for 12 months post-ACS; then aspirin monotherapy",
        ]
    },
]

col_x3 = [0.2, 6.85]
row_y3 = [1.1, 4.35]
for i, section in enumerate(guideline_sections):
    x = col_x3[i % 2]
    y = row_y3[i // 2]
    w = 6.2
    h = 3.0
    add_rect(slide, x, y, w, 0.4, section["color"])
    add_text(slide, section["title"], x+0.08, y+0.02, w-0.12, 0.36,
             font_size=11.5, bold=True, color=WHITE, wrap=True)
    add_rect(slide, x, y+0.4, w, h-0.4, WHITE)
    for j, pt in enumerate(section["points"]):
        add_text(slide, f"• {pt}", x+0.1, y+0.44+j*0.42, w-0.18, 0.4,
                 font_size=9.3, color=DARK_GRAY, wrap=True)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 15 — QUICK REFERENCE DOSAGE TABLE
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, DARK_BLUE)
add_text(slide, "Quick Reference — Antiplatelet Drug Dosage & Duration", 0.3, 0.05, 12.5, 0.9,
         font_size=24, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

headers3 = ["Drug", "Class", "Route", "Loading Dose", "Maintenance Dose", "Duration", "Key Indication"]
col_x4 = [0.15, 1.85, 2.85, 3.65, 5.25, 7.05, 9.05]
col_w4 = [1.65, 0.95, 0.75, 1.55, 1.75, 1.95, 4.15]

all_drugs = [
    ["Aspirin", "COX-I", "Oral", "162–325 mg stat", "75–100 mg OD", "Lifelong", "ACS, PCI, CABG, stroke (secondary prevention)"],
    ["Clopidogrel", "P2Y12", "Oral", "300–600 mg", "75 mg OD", "1–12 months", "ACS, PCI (BMS/DES), TIA/stroke, PAD"],
    ["Prasugrel", "P2Y12", "Oral", "60 mg", "10 mg OD (5 mg if <60kg / ≥75yr)", "12 months", "ACS + PCI only (post-angiography); avoid prior stroke/TIA"],
    ["Ticagrelor", "P2Y12", "Oral", "180 mg", "90 mg BID (×12 mo)\n60 mg BID (>12 mo)", "12 months (std)\nExtended possible", "ACS (all strategies); highest-risk post-MI extended prevention"],
    ["Cangrelor", "P2Y12", "IV only", "30 µg/kg IV bolus", "4 µg/kg/min IV infusion", "Procedure duration (≥2 hr)", "PCI adjunct; bridging; pre-op patients on DAPT"],
    ["Abciximab", "GP IIb/IIIa", "IV only", "0.25 mg/kg IV bolus", "0.125 µg/kg/min (max 10 µg/min) × 12 hr", "12 hours infusion", "High-risk PCI; STEMI with high thrombus burden"],
    ["Eptifibatide", "GP IIb/IIIa", "IV only", "180 µg/kg IV (repeat ×1)", "2 µg/kg/min × 18–24 hr", "18–24 hours", "ACS (NSTEMI/UA), PCI adjunct; dose-reduce CrCl <50"],
    ["Tirofiban", "GP IIb/IIIa", "IV only", "25 µg/kg over 3 min", "0.15 µg/kg/min × 18–24 hr", "18–24 hours", "ACS (NSTEMI/UA), PCI adjunct; dose-reduce in renal impairment"],
    ["Vorapaxar", "PAR-1 Antag.", "Oral", "None", "2.08 mg OD", "Chronic (secondary prevention)", "Secondary prevention post-MI (no prior stroke/TIA)"],
    ["Dipyridamole", "PDE Inhibitor", "Oral", "None", "200 mg ER twice daily (+ ASA)", "Chronic", "Stroke prevention (combined with aspirin — Aggrenox)"],
    ["Cilostazol", "PDE Inhibitor", "Oral", "None", "100 mg twice daily", "Chronic", "Peripheral artery disease (intermittent claudication)"],
    ["Ticlopidine", "P2Y12 (older)", "Oral", "None", "250 mg twice daily", "Variable", "TIA/stroke (ASA-intolerant); rarely used due to toxicity"],
]

y_tbl3 = 1.1
hdr_h3 = 0.38
row_h3 = 0.5
add_rect(slide, 0.15, y_tbl3, 13.0, hdr_h3, DARK_BLUE)
for ci, (hdr, cx, cw) in enumerate(zip(headers3, col_x4, col_w4)):
    add_text(slide, hdr, cx+0.03, y_tbl3+0.02, cw-0.05, hdr_h3-0.04,
             font_size=10, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
             anchor=MSO_ANCHOR.MIDDLE)

row_colors = [
    RGBColor(0xFF, 0xEB, 0xEB),  # aspirin - red tint
    RGBColor(0xE8, 0xF8, 0xE8),  # clopidogrel
    RGBColor(0xE8, 0xF8, 0xE8),  # prasugrel
    RGBColor(0xE8, 0xF8, 0xE8),  # ticagrelor
    RGBColor(0xE8, 0xF8, 0xE8),  # cangrelor
    RGBColor(0xFF, 0xEB, 0xEB),  # abciximab
    RGBColor(0xEA, 0xF2, 0xFF),  # eptifibatide
    RGBColor(0xEA, 0xF2, 0xFF),  # tirofiban
    RGBColor(0xFD, 0xF2, 0xE4),  # vorapaxar
    RGBColor(0xE8, 0xF8, 0xF4),  # dipyridamole
    RGBColor(0xE8, 0xF8, 0xF4),  # cilostazol
    WHITE,                        # ticlopidine
]

for ri, (row, bg) in enumerate(zip(all_drugs, row_colors)):
    y_row = y_tbl3 + hdr_h3 + ri * row_h3
    add_rect(slide, 0.15, y_row, 13.0, row_h3, bg)
    for ci, (val, cx, cw) in enumerate(zip(row, col_x4, col_w4)):
        is_bold = ci == 0
        col = DARK_BLUE if ci == 0 else (ACCENT_RED if ci == 5 else DARK_GRAY)
        add_text(slide, val, cx+0.03, y_row+0.01, cw-0.05, row_h3-0.02,
                 font_size=8.5, bold=is_bold, color=col,
                 align=PP_ALIGN.LEFT, anchor=MSO_ANCHOR.MIDDLE, wrap=True)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 16 — SUMMARY & KEY TAKEAWAYS
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 1.0, DARK_BLUE)
add_text(slide, "Summary & Key Takeaways", 0.3, 0.05, 12.5, 0.9,
         font_size=28, bold=True, color=WHITE)
add_rect(slide, 0, 1.0, 13.333, 6.5, LIGHT_GRAY)

takeaways = [
    (ACCENT_RED, "COX Inhibitor (Aspirin):",
     "Backbone of antiplatelet therapy. 81 mg/day lifelong for all secondary prevention. Irreversible COX-1 inhibition — effect lasts platelet lifespan (10 days). Chewable 162–325 mg for ACS loading."),
    (ACCENT_GREEN, "P2Y12 Inhibitors (DAPT pillar):",
     "Ticagrelor/prasugrel > clopidogrel in ACS/PCI (faster, more predictable inhibition). Clopidogrel first-line for stable angina PCI, TIA/stroke. Cangrelor is IV bridge option. DAPT = aspirin + P2Y12 for 12 months post-ACS."),
    (MED_BLUE, "GP IIb/IIIa Inhibitors:",
     "Reserved for high-risk PCI or refractory ACS patients not pre-treated. IV only; short-term use. Abciximab reversible by platelet transfusion; eptifibatide/tirofiban are not. Falling out of routine use with potent oral P2Y12 agents."),
    (ORANGE, "DAPT Duration Principles:",
     "Standard: 12 months post-ACS. May extend (60 mg ticagrelor BID) if high ischemic risk. May shorten to 1–3 months in high bleeding risk (HBR) then P2Y12 monotherapy. Balance ischemic vs bleeding risk using PRECISE-DAPT and DAPT score tools."),
    (ACCENT_TEAL, "Special Situations:",
     "Avoid prasugrel in prior stroke/TIA or age ≥75 (or use 5 mg). Stop P2Y12 before surgery: clopidogrel 5d, ticagrelor 5d, prasugrel 7d, cangrelor 1h. ASA + NOAC: triple therapy — minimize by stopping ASA after 4 weeks post-PCI."),
    (DARK_BLUE, "Latest Guidelines (2025/2026):",
     "2025 ACC/AHA: Ticagrelor preferred for NSTE-ACS; ticagrelor monotherapy ≥1 month post-PCI is Class I. 2026 ACC Statement: comprehensive ASCVD spectrum framework. De-escalation strategies are guideline-endorsed alternatives."),
]

for i, (col, title, text) in enumerate(takeaways):
    row = i % 3
    col_n = i // 3
    x = 0.2 + col_n * 6.6
    y = 1.15 + row * 1.75
    w = 6.2
    add_rect(slide, x, y, 0.45, 1.45, col)
    add_text(slide, str(i+1), x, y, 0.45, 1.45, font_size=18, bold=True,
             color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, x+0.45, y, w-0.45, 1.45, WHITE)
    add_text(slide, title, x+0.55, y+0.06, w-0.62, 0.35,
             font_size=12, bold=True, color=col)
    add_text(slide, text, x+0.55, y+0.42, w-0.62, 0.98,
             font_size=9.5, color=DARK_GRAY, wrap=True)

# Footer on all slides (slide count)
# Note: already done inline

# ══════════════════════════════════════════════════════════════════════════════
# SAVE
# ══════════════════════════════════════════════════════════════════════════════
output_path = "/tmp/workspace/antiplatelet-pptx/Antiplatelet_Drugs_CVD_Management.pptx"
buf = BytesIO()
prs.save(buf)
with open(output_path, "wb") as f:
    f.write(buf.getvalue())

print(f"Presentation saved: {output_path}")
print(f"Total slides: {len(prs.slides)}")
print(f"File size: {len(buf.getvalue()) // 1024} KB")