National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016

Chew, Derek P.; Scott, Ian A; Cullen, Louise; French, John K.; Briffa, Tom; Tideman, Philip; Woodruffe, Stephen; Kerr, Alistair; Branagan, Maree; Aylward, Philip E.

doi:10.5694/mja16.00368

Cited by 152 publications

(139 citation statements)

References 47 publications

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“…6,7 On the basis of this trial, ticagrelor is now recommended as first-line therapy for patients with ACS in international guidelines. [8][9][10] Although ticagrelor represents advancement in antiplatelet therapy, several adverse effects have been reported. 11,12 In the PLATO trial, treatment with ticagrelor resulted in a small but significant increase in noncoronary artery bypass grafting (CABG)-related major bleeding when compared to clopidogrel.…”

Section: Introductionmentioning

confidence: 99%

Contemporary antiplatelet therapy in acute coronary syndromes: are there differences in outcomes and discontinuation between clopidogrel and ticagrelor?

Harding¹,

Holley

Wilkins

et al. 2017

Internal Medicine Journal

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Section: Introductionmentioning

confidence: 99%

Contemporary antiplatelet therapy in acute coronary syndromes: are there differences in outcomes and discontinuation between clopidogrel and ticagrelor?

Harding¹,

Holley

Wilkins

et al. 2017

Internal Medicine Journal

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“…Statins are a widely used class of drugs that has an established benefit in patients with ischaemic heart disease (IHD) at the highest tolerated doses [1–3]. Statin associated rhabdomyolysis (SAR), although rare, is a well-recognized life threatening adverse effect [4].…”

Section: Introductionmentioning

confidence: 99%

Severe Rhabdomyolysis due to Presumed Drug Interactions between Atorvastatin with Amlodipine and Ticagrelor

Banakh

Haji

Kung

et al. 2017

Case Reports in Critical Care

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Atorvastatin and ticagrelor combination is a widely accepted therapy for secondary prevention of ischaemic heart disease. However, rhabdomyolysis is a well-known rare side effect of statins which should be considered when treatments are combined with cytochrome P450 3A4 enzyme inhibitors. We report a case of atorvastatin and ticagrelor associated severe rhabdomyolysis that progressed to multiorgan failure requiring renal replacement therapy, inotropes, intubation, and mechanical ventilation. Despite withdrawal of the precipitating cause and the supportive measures including renal replacement therapy, creatinine kinase increased due to ongoing rhabdomyolysis rapidly progressing to upper and lower limbs weakness. A muscle biopsy was performed to exclude myositis which confirmed extensive myonecrosis, consistent with statin associated rhabdomyolysis. After a prolonged ventilatory course in the intensive care unit, patient's condition improved with recovery from renal and liver dysfunction. The patient slowly regained her upper and lower limb function; she was successfully weaned off the ventilator and was discharged for rehabilitation. To our knowledge, this is a second case of statin associated rhabdomyolysis due to interaction between atorvastatin and ticagrelor. However, our case differed in that the patient was also on amlodipine, which is considered to be a weak cytochrome P450 3A4 inhibitor and may have further potentiated myotoxicity.

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“…Within improved protocols for chest pain assessment and diagnosis, early coronary angiography for high-risk chest pain is increasingly emphasised [97]. Rates of emergent coronary angiography in reported cases of P-SCAD have significantly increased across the documented time periods.…”

Section: Management and Outcomesmentioning

confidence: 99%

Evolving Management and Improving Outcomes in Pregnancy-Associated Spontaneous Coronary Artery Dissection (P-SCAD) Systematic Review

Paratz

Kao

MacIsaac

et al. 2017

Heart, Lung and Circulation

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Background: Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is defined as SCAD occurring during pregnancy or within 3 months post-partum. Earlier systematic reviews have suggested a high maternal and foetal mortality rate. We undertook a structured systematic review of P-SCAD demographics, management and maternal and foetal outcomes. Methods: Case study identification was conducted according to PRISMA guidelines, with screening of all published P-SCAD cases not meeting pre-defined exclusion criteria. Of two hundred and seventy-three publications screened, one hundred and thirty-eight cases met inclusion criteria. Cases were allocated to one of three time periods; 1960-85 (twenty cases) reflecting early management of P-SCAD, 1986-2005 (forty-two cases) reflecting recent management, and 2006-16 (seventy-six cases), reflecting contemporary management. Results: The only significant demographic change in women experiencing P-SCAD over the last 50 years was an increasing proportion of primigravidas (p = 0.02). Management and outcomes, however, have altered significantly. Emergent angiography (p b 0.0001), reduced thrombolysis (p = 0.006) and increasingly conservative or percutaneous management (p b 0.0001) are associated with dramatic reductions in maternal mortality (85% in earliest reports to 4% in the last decade, p b 0.0001) and foetal mortality (50% in earliest reports to 0.0% in the last decade, p = 0.023). Conclusion: This systematic review of temporal changes in presentation, management and outcomes of P-SCAD represents the widest range of variables analysed in the largest cohort of P-SCAD patients to date. In the setting of earlier coronary angiography and increasingly conservative management, maternal and foetal survival rates continue to improve. Keywords:Spontaneous coronary dissection Pregnancy Interventional cardiology Case studyA 35-year-old G2P0 woman presented with chest pain and anterior ST elevation at ± 34 weeks and 3 days gestation of an in vitro fertilisation (IVF) pregnancy. She had undergone two cycles of IVF therapy prior to pregnancy, and received a standard regime of hormonal stimulation. After discussion with the treating obstetrician, the cardiac catheterization laboratory was activated, with midwives and an obstetrics registrar on standby for urgent delivery in case of foetal distress or maternal arrest.Radial coronary angiography performed with minimal contrast (70 mL), minimal radiation (skin dose 88 mGy), and abdominal shielding. A spontaneous dissection of our patient's distal left anterior descending artery was found. Due to her haemodynamic stability, the decision was made to treat her conservatively with optimal medical therapy.Our patient commenced aspirin, clopidogrel, metoprolol and a heparin infusion (subsequently changed over to enoxaparin). Her electrocardiogram evolved to show anterior Q waves, and troponin peaked at 40,494 ng/L (normal b 16 ng/L). Echocardiography showed anterior hypokinesis with an ejection fraction (LVEF) of 40%, and spontaneous echo...

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National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016

Cited by 152 publications

References 47 publications

Contemporary antiplatelet therapy in acute coronary syndromes: are there differences in outcomes and discontinuation between clopidogrel and ticagrelor?

Contemporary antiplatelet therapy in acute coronary syndromes: are there differences in outcomes and discontinuation between clopidogrel and ticagrelor?

Severe Rhabdomyolysis due to Presumed Drug Interactions between Atorvastatin with Amlodipine and Ticagrelor

Evolving Management and Improving Outcomes in Pregnancy-Associated Spontaneous Coronary Artery Dissection (P-SCAD) Systematic Review

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