Patients with life-threatening VAs secondary to CAS are at particularly high-risk for recurrence, especially when insufficient medical therapy is administered. Non-dihydropyridine CCBs are capable of suppressing episodes, whereas beta-blocker treatment is predictive of VAs. Ultimately, in spite of medical intervention, some patients exhibited arrhythmogenic events in the long-term, suggesting that ICD implantation may still be indicated for all.
Background
Prasugrel and ticagrelor are new antiplatelet agents developed for patients with Acute Coronary Syndrome (ACS) and high risk of thrombosis. Their benefits in terms of mortality and major cardiovascular events have been well established, but some concerns remain regarding their safety.
Purpose
To analyse antiplatelet prescriptions focusing on new drugs and with a subgroup analysis (diabetes, renal function, age, weight, risk of haemorrhage).
Materials and methods
A retrospective observational study was carried out in our healthcare area from January to June 2013. Patients included had ACS and required antiplatelet therapy. Demographic and clinical data were obtained from electronic medical records (Historia de Salud, PowerChart-Millennium and Intensive Care Unit programme). The CRUSADE scale was used to calculate the bleeding risk.
Results
379 patients were included (72.8% male, mean age 64.9 ± 12.8 years, 134 patients diagnosed with ST-Segment Elevation Myocardial Infarction and 245 with Non-ST Elevation Myocardial Infarction). During hospitalisation, 350 patients received clopidogrel and only 52 were treated with new drugs (29 with prasugrel and 23 ticagrelor); 37 of these received clopidogrel initially and then switched to a new drug. 9 deaths occurred during hospitalisation. At discharge, 280 patients continued with dual antiplatelet therapy (239 with clopidogrel and aspirin (AAS), 27 with prasugrel-AAS and 15 with ticagrelor-AAS), 81 with single treatment (64 with AAS and 17 with clopidogrel) and 9 interrupted the treatment. See Subgroup analysis on patients with dual therapy in Table 1.
Abstract CP-115 Table 1
Clopidogrel
Prasugrel
Ticagrelor
Diabetic (n = 98)
79
16
3
ClCr <60 ml/min at admission (n = 46)
44
2
0
Age >75 years (n = 60)
58
0
2
Weight <60 kg (n = 25)
25
0
0
Risk of haemorrhage:
•High (CRUSADE ≥41 points) (n = 35)
33
2
0
•Low/moderate (CRUSADE ≤30 points) (n = 212)
172
25
15
Conclusions
Use of new antiplatelet drugs in our healthcare area is still moderate. They are prescribed only in selected cases with low bleeding risk. The results show only a disposition towards prescribing prasugrel for diabetic patients according to the clinical trials results, but not in other subgroups that can benefit from new drugs.
No conflict of interest.
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