Prehospital clopidogrel use and STEMI management: a review

2021 ◽  
Vol 13 (6) ◽  
pp. 1-10
Author(s):  
Rachelle Hollier ◽  
Madison Sealy ◽  
Nathan Ross ◽  
Phillip Ebbs
Keyword(s):  
Myocardial Infarction ◽  
Clinical Practice ◽  
Standard Treatment ◽  
Efficacy And Safety ◽  
Journal Articles ◽  
Pharmacological Interventions ◽  
Treatment Regimens ◽  
Prehospital Management ◽  
St Elevation ◽  
Standard Treatment Regimen

Clopidogrel is an anticoagulant commonly used in the prehospital environment for the management of ST-elevation myocardial infarction (STEMI). Some ambulance services have incorporated this into their treatment regimens; however, others hold a variety of alternative pharmacological interventions. This study examines and determine the pharmacological efficacy and safety of clopidogrel in the management of patients with STEMI and assess whether ambulance services should use the drug as part of standard practice. A literature review was conducted to identify articles relating to the administration of clopidogrel in the prehospital setting. Fourteen peer-reviewed journal articles and eight clinical practice guidelines from international ambulance services were included in this review. According to this review, clopidogrel has been deemed safe, effective and practical for widespread use in the prehospital environment for the management of STEMI. However, some disagreement has arisen over whether clopidogrel is a more favourable anticoagulant than ticagrelor and prasugrel. Anticoagulants such as clopidogrel should be strongly considered as a standard treatment regimen in the prehospital management of STEMI across international jurisdictions.

Appropriateness of oral clopidogrel for prehospital STEMI management

2021 ◽  
Vol 11 (1) ◽  
pp. 4-14
Author(s):  
Madison Sealy ◽  
Rachelle Hollier
Keyword(s):  
Myocardial Infarction ◽  
Literature Review ◽  
Standard Treatment ◽  
Efficacy And Safety ◽  
Journal Articles ◽  
Pharmacological Interventions ◽  
Treatment Regimens ◽  
Prehospital Management ◽  
St Elevation ◽  
Standard Treatment Regimen

Introduction: Clopidogrel is an anticoagulant commonly used in the prehospital environment for the management of ST-elevation myocardial infarction (STEMI). Some ambulance services have incorporated this into their treatment regimens; however, others hold a variety of alternative pharmacological interventions. Aims: The purpose of this study is to examine and determine the pharmacological efficacy and safety of clopidogrel in the management of patients with STEMI and assess whether ambulance services should use the drug as part of standard practice. Methods: A literature review was conducted to identify articles relating to the administration of clopidogrel in the prehospital setting. Fourteen peer-reviewed journal articles and eight clinical practice guidelines from international ambulance services were included in this review. Results: According to this literature review, clopidogrel has been deemed safe, effective and practical for widespread use in the prehospital environment for the management of STEMI. However, some disagreement has arisen over whether clopidogrel is a more favourable anticoagulant than ticagrelor and prasugrel. Conclusion: Anticoagulants such as clopidogrel should be strongly considered as a standard treatment regimen in the prehospital management of STEMI across international jurisdictions.

scholarly journals ANalgesic Efficacy and safety of MOrphiNe versus methoxyflurane in patients with acute myocardial infarction: the rationale and design of the ANEMON-SIRIO 3 study: a multicentre, open-label, phase II, randomised clinical trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e043330
Author(s):  
Aldona Kubica ◽  
Agata Kosobucka ◽  
Piotr Niezgoda ◽  
Piotr Adamski ◽  
Katarzyna Buszko ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Analgesic Efficacy ◽  
Randomised Clinical Trial ◽  
Ethical Standards ◽  
Loading Dose ◽  
Efficacy And Safety ◽  
Open Label ◽  
Analgesic Treatment ◽  
Open Label Phase ◽  
St Elevation

IntroductionThe unfavourable influence of morphine on the pharmacokinetics of ticagrelor resulting in weaker and retarded antiplatelet effect in patients with acute coronary syndrome (ACS) has been previously shown. Replacing morphine with methoxyflurane, a potent, non-opioid analgesic agent, that does not weaken or delay the effect of antiplatelet agents may improve the clinical efficacy of treatment of patients with ACS.MethodsThe ANEMON-SIRIO 3 study was designed as a multicentre, open-label, phase II, randomised clinical trial aimed to test the analgesic efficacy and safety of methoxyflurane in patients with ACS. The study population will comprise patients with ST-elevation myocardial infarction or non-ST-elevation ACS admitted to the study centres with typical chest pain requiring analgesic treatment. Before percutaneous coronary intervention (PCI) for the patients with index ACS will be randomly assigned in 1:1 ratio to receive methoxyflurane administered by inhalation, or to obtain morphine administered intravenously. Analgesic treatment will be followed by 300 mg loading dose of aspirin and 180 mg loading dose of ticagrelor. Patients will be assessed with regard to pain intensity according to the Numeric Pain Rating Scale at baseline, 3 min after study drug administration and immediately after PCI. Moreover, patients will be actively monitored with regard to the occurrence of side effects of evaluated therapies, as well as adverse events that may be related to insufficient platelet inhibition (no-reflow phenomenon assessed immediately after PCI, administration of GPIIb/IIIa inhibitors during PCI, acute stent thrombosis).Ethics and disseminationThe study will be conducted in six Polish clinical centres from the beginning of in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.Trial registration detailsClinicalTrials.gov, NCT04476173.

scholarly journals Professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness: A systematic review using the framework method and pillar process

2021 ◽  
pp. 026921632110321
Author(s):  
Florence Reedy ◽  
Mark Pearson ◽  
Sarah Greenley ◽  
Joseph Clark ◽  
David C Currow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
A Priori ◽  
Synthesis Method ◽  
Patient Characteristics ◽  
Severe Illness ◽  
Pharmacological Interventions ◽  
Eligibility Criteria ◽  
Treatment Regimens ◽  
Appraisal Tool

Background: In combination with non-pharmacological interventions, opioids may safely reduce chronic breathlessness in patients with severe illness. However, implementation in clinical practice varies. Aim: To synthesise the published literature regarding health professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness, identifying issues which influence implementation in clinical practice. Design: Systematic review and synthesis using the five-stage framework synthesis method. Data sources: Three electronic databases (MEDLINE, Embase via OVID, ASSIA via Proquest) were searched (March 2020) using a predefined search strategy. Studies were also citation chained from key papers. Papers were screened against a priori eligibility criteria. Data were extracted from included studies using the framework synthesis method. Qualitative and quantitative data were synthesised using the pillar process. Included studies were critically appraised using the Mixed-Methods Appraisal Tool. Results: After de-duplication, 843 papers were identified. Following screening, 22 studies were included. Five themes were developed: (i) clinician/patient characteristics, (ii) education/knowledge/experience, (iii) relationship between clinician/family, (iv) clinician/patient fear of opioids and (v) regulatory issues. Conclusions: There are significant barriers and enablers to the use of opioids for the symptomatic reduction of chronic breathlessness based on the knowledge, views and attitudes of clinicians, patients and families. Clinicians’ interactions with patients and their families strongly influences adherence with opioid treatment regimens for chronic breathlessness. Clinicians’, patients’ and families’ knowledge about the delicate balance between benefits and risks is generally poor. Education for all, but particularly clinicians, is likely to be a necessary (but insufficient) factor for improving implementation in practice.

A Promising Innovative Treatment for ST-Elevation Myocardial Infarction: The Use of C-Reactive Protein Selective Apheresis: Case Report

2020 ◽  
Vol 49 (6) ◽  
pp. 753-757 ◽  
Author(s):  
Darko Boljevic ◽  
Aleksandra Nikolic ◽  
Sinisa Rusovic ◽  
Jovana Lakcevic ◽  
Milovan Bojic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Efficacy And Safety ◽  
C Reactive Protein ◽  
Complete Evaluation ◽  
Autologous Plasma ◽  
Reactive Protein ◽  
St Elevation

<b><i>Background:</i></b> In patients with ST-elevation myocardial infarction (STEMI), C-reactive protein (CRP) levels are associated with larger infarct size, transmural extent, and poor function of left ventricle and independently predict 30-day mortality. CRP-apheresis following STEMI showed to be feasible, safe, and has significant beneficial effect both on myocardial infarction size and wall motion. To the best of our knowledge, this is only the second published clinical evaluation of the efficacy and safety of selective CRP-apheresis in the STEMI treatment using Spectra-Optia and Pentrasorb CRP-adsorber systems. <b><i>Case Report:</i></b> A 53-year-old female was referred with anterior STEMI. After percutaneous coronary intervention, patient received standard post-STEMI therapy according to current guidelines. Selective therapeutic plasma exchange (TPE) was performed using Spectra-Optia (Terumo BCT; USA) and Pentrasorb CRP-adsorber (Pentracor GmbH; Germany) systems. Antecubital veins were used for vascular access and acid-citrate-dextrose solution (ACD formula A; total volume = 1,026 mL) was utilized as anticoagulant. The volume of processed blood was 15,600 mL. The removed “natural” plasma (total volume = 8,329 mL) was replaced with CRP-depleted autologous plasma (total volume = 8,085 mL). This intensive TPE-treatment was well tolerated, without adverse effects, or complications. The CRP plasma levels were: initial = 4.2 mg/L 6 h after acute myocardial infarction (AMI), pre-apheresis = 16.4 mg/L, and post-apheresis = 4.59 mg/L (CRP-depletion = 72%). There were neither significant changes observed in biochemistry nor any alterations in plasma hemostatic activity investigated before and after CRP-adsorption performed. <b><i>Conclusion:</i></b> Early performed CRP-apheresis is a promising innovative therapeutic approach for STEMI treatment that could provide a reduced size of infarction zone – with inferior occurrence of heart failure after AMI. However, precise and complete evaluation of the efficacy and safety of this treatment requires further multicenter randomized and larger clinical studies.

scholarly journals Treatment of patients with acute coronary syndrome in real clinical practice in the Republic of Karelia: 10-years registry results

2021 ◽  
Vol 11 (4) ◽  
pp. 15-19
Author(s):  
Inga S. Skopets ◽  
Natalia N. Vezikova ◽  
Tamazi D. Karapetian ◽  
Andrew V. Malafeev ◽  
Aleksandr N. Malygin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Drug Therapy ◽  
Hospital Mortality ◽  
Coronary Syndrome ◽  
Cardiovascular Center ◽  
St Elevation ◽  
The Republic ◽  
Real Clinical Practice

Aim. To present the treatment of Acute coronary syndrome (ACS) in clinical practice in the Republic of Karelia and the results of Cardiovascular centers working. Material and methods. The prospective study included 9949 patients successively hospitalized from 01.01.2020 to 01.01.2020 in the Regional cardiovascular center (Petrozavodsk, Russia), 6335 were included in Federal register. Risk factors, clinical features, reperfusion strategy as well as the rate of clinical complications, drug therapy and outcomes were assessed. Results. 9949 patients were treated in Regional cardiovascular center from 01.01.2010 to 01.01.2020 due to acute coronary syndrome, and 6335 were included to the Federal registry. 40.2% of patients had ST-elevation Myocardial Infarction and 59.8% ACS without ST elevation. The first group was younger (the average age was 69) than the second (the average age was 74). The drug therapy of ACS in the hospital was following: 98.7% of patients took aspirin; b-blockers 92.3%, statins 97.4%. The outcomes of ACS during the hospital discharge were following: Q-wave myocardial infarction (MI) was diagnosed in 34.2% cases, non-Q-wave MI in 23.4%, unstable angina 20.5%, repeated MI 18.7% and 2.5% MI unspecified localization. The analysis of the clinical features of ACS shows that significant number of patients (24.8%) had severe complications. So, ventricle arrhythmias were diagnosed in 17.3% of cases, acute left ventricle insufficiency in 7.6%, cardiogenic shock in 3.0%, cardiac arrest in 1.9%, myocardial rupture in 0.4%. The hospital mortality rate reached 6.38%. Conclusion. The article presents data about treatment of patients with acute coronary syndrome in real clinical practice in the Republic of Karelia based on 10-years register. Difficulties of management and reperfusion interventions, the volume of drug therapy, the frequency of complications, as well as outcomes and hospital mortality are discussed. The presented data show the results of modernization of the medical care program for patients with acute coronary syndrome in practical healthcare in the region.

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