Antiplatelet and anticoagulation pretreatment in acute coronary syndrome: current guidelines and unresolved issues.

Objective: To determine the frequency of bleeding with Tirofiban during percutaneous coronary intervention Methodology: In this case series (Descriptive) at Mayo Hospital, Cardiology Deptt. Lahore during the year 2018 and 2019, we enrolled a total of 385 cases of either gender with acute coronary syndrome(ACS) and undergoing percutaneous coronary intervention(PCI)were included. Preloading with aspirin 300 mg and clopidogrel 600 mg was done. Intravenous Tirofiban was given keeping in mind the current guidelines. Tirofiban was given as I/V bolus of 0.25 mcg/kg over 5 minutes during/before the start of PCI. It was followed by a continuous infusion of 0.125 mcg/kg/min for up to eighteen hours. Bleeding during and within 24 hours of percutaneous coronary intervention was noted according to BARC bleeding type Results: Mean age was 50.750± 5.63years. Male gender was dominant i.e. 85.7% as compare to 14.3% females. Bleeding was observed in 3.9% patients Conclusion: In acute coronary syndrome patients undergoing PCI, Tirofiban use was associated with bleeding. In the modern era of PCI, the judicious use of Tirofiban is safe. Keywords: Percutaneous coronary intervention, Tirofiban, Bleeding, Acute coronary syndrome

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Acute Coronary Syndrome in Octogenerians: Management Perspectives

Journal of Integrative Cardiology Open Access ◽

10.31487/j.jicoa.2020.04.19 ◽

2020 ◽

pp. 1-4

Author(s):

Ranjan Modi ◽

Sunil Modi ◽

Ranjan Modi

Keyword(s):

Clinical Trials ◽

Acute Coronary Syndrome ◽

Elderly Patients ◽

Medical Therapy ◽

Randomized Clinical Trials ◽

Coronary Syndrome ◽

Younger Age ◽

Current Guidelines ◽

Term Data

Current guidelines for acute coronary syndrome are derived from the data in randomized clinical trials and metanalysis conducted in patients. These patients are generally of younger age. The data of acute coronary syndrome in octogenarians is mainly derived from registries. This mid and long-term data regarding medical therapy or interventions in octogenarians is low in number with smaller subsets of patients. Most of the physicians are reluctant to use the same guidelines in these elderly patients due to increased chances of complications. This article reviews the available data and literature in acute coronary syndrome in octogenarians and provides management perspectives for these elderly patients.

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Cardiovascular Disease in Antiphospholipid Syndrome

Current Vascular Pharmacology ◽

10.2174/1570161117666190830101341 ◽

2020 ◽

Vol 18 (6) ◽

pp. 538-548

Author(s):

Kali Polytarchou ◽

Dimitrios Varvarousis ◽

Antonis S. Manolis

Keyword(s):

Cardiovascular Disease ◽

Acute Coronary Syndrome ◽

General Population ◽

Antiphospholipid Syndrome ◽

Antiphospholipid Antibodies ◽

Anticoagulation Therapy ◽

Cardiovascular Complications ◽

Systemic Autoimmune Disease ◽

Coronary Syndrome ◽

Current Guidelines

: Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by venous, arterial or microvascular thrombosis or obstetric events in the presence of persistently positive antiphospholipid antibodies and constitutes a major cause of cardiovascular events in young people. Τhis review highlights the pathophysiology of cardiovascular complications in patients with APS and possible treatment options. : Patients with APS have endothelial dysfunction, accelerated endothelial proliferation and intimal hyperplasia, atherogenesis, platelet activation, inflammatory products secretion and coagulation-fibrinolytic dysregulation. Cardiovascular complications include accelerated atherosclerosis, acute coronary syndrome, Libman-Sacks endocarditis, cardiomyopathy and venous, arterial or intracardiac thrombi. Moreover, pulmonary hypertension and peripheral microvascular dysfunction are common findings. : Management of these patients is not well documented. The role of primary thrombosis prevention remains controversial in individuals with positive antiphospholipid antibodies. Treatment of traditional cardiovascular risk factors according to current guidelines for the prevention of cardiovascular disease in the general population is recommended for primary prevention of APS. Anticoagulation therapy with unfractionated or low-molecular-weight heparin overlapped with a vitamin K antagonist remains the mainstay of the treatment for APS patients with venous thrombosis, whereas direct oral anticoagulants are not yet recommended. Data are scarce regarding the secondary arterial thrombosis prevention and it is not clear whether dual or triple antithrombotic therapy is necessary. To date, it is recommended to follow current guidelines for the management of acute coronary syndrome in the general population. New treatment targets are promising options for patients with catastrophic APS.

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Patterns of treatment with antiplatelet therapy after an acute coronary syndrome: Data from a large database in a community setting

European Journal of Preventive Cardiology ◽

10.1177/2047487318814970 ◽

2018 ◽

Vol 26 (8) ◽

pp. 836-846 ◽

Cited By ~ 6

Author(s):

Claudio Cimminiello ◽

Letizia Dondi ◽

Antonella Pedrini ◽

Giulia Ronconi ◽

Silvia Calabria ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Antiplatelet Therapy ◽

Healthcare Costs ◽

Dual Therapy ◽

Antiplatelet Drug ◽

Antiplatelet Treatment ◽

Coronary Syndrome ◽

One Year ◽

Current Guidelines

Aims Current guidelines strongly recommend antiplatelet therapy with aspirin plus a P2Y12 receptor inhibitor (dual therapy) for patients with acute coronary syndrome (ACS). To better understand how antiplatelet treatment is prescribed in clinical practice, the aim of this study was to provide a more detailed description of real-world patients with and without antiplatelet treatment after an ACS, their outcomes at one-year follow-up and the related integrated cost. Methods The ReS database, including more than 12 million inhabitants, was evaluated. During the accrual period ACS patients discharged alive were identified on the basis of ICD-IX-CM code. Antiplatelet drug prescriptions and healthcare costs were analysed over one-year follow-up. Results In 2014, of the 25,129 patients discharged alive after an ACS, 5796 (23%) did not receive any antiplatelet therapy during the first month after hospital discharge. Among them, 3846 (66%) subjects were prescribed an antiplatelet drug subsequently, while 7.7% did not receive any antiplatelet treatment during the whole following year. Dual therapy in the subgroup of patients undergoing a revascularization procedure ( n = 8436) was prescribed to 79.2% of cases and to 46.1% ( n = 4009) of medically managed patients. The patients not treated with an antiplatelet treatment in the first month showed the highest one-year healthcare costs, mostly due to hospital re-admissions. Conclusions This analysis of a large patient community shows that a considerable proportion of patients remained untreated with antiplatelet treatment after an ACS event. A clearer characterization of these subjects can help to improve the adherence to the current guidelines and recommendations.

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APPLICATION OF RIVAROXABAN IN ACUTE CORONARY SYNDROME: EVIDENCE AND CURRENT GUIDELINES

Russian Journal of Cardiology ◽

10.15829/1560-4071-2016-1-68-72 ◽

2016 ◽

pp. 68-72

Author(s):

O. V. Averkov

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Syndrome ◽

Current Guidelines

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The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome

BMC Emergency Medicine ◽

10.1186/s12873-021-00523-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kristijan B. Todoroski

Keyword(s):

Acute Coronary Syndrome ◽

Ecg Changes ◽

Pain Experience ◽

Coronary Syndrome ◽

Pain Scores ◽

Subjective Pain ◽

Prospective Trials ◽

National Emergency ◽

Fast Acting ◽

Current Guidelines

Abstract Background Both chewed aspirin and sublingual nitroglycerin are fast acting medications and reach therapeutic levels within a few minutes. Current guidelines for managing acute coronary syndrome (ACS) do not recognize the importance of the order or timing of administering aspirin and nitroglycerin. This retrospective study aimed to examine if there was any benefit to the timing of giving aspirin before or after nitroglycerin in cases of ACS. Methods From the large National Emergency Medical Services Information System (NEMSIS) 2017 Version database, 2594 patients with acute coronary syndrome were identified (based on chest pain and their ECG finding) that received aspirin plus nitroglycerin in prehospital settings. Based on which medication was given first, the patients were separated in 2 groups: an aspirin-first and a nitroglycerin-first group. The 2246 patients who received aspirin first were further stratified based on the time between administration of aspirin and the first dose of nitroglycerin. The other 348 patients who received nitroglycerin first were similarly stratified. Results In patients with STEMI ischemia, giving nitroglycerin 10 min after aspirin dosing (compared to giving them simultaneously) leads to a greater than 20% reduction in need for additional nitroglycerin, a greater than 7% decrease in subjective pain experienced by the patient and reduced need for additional opioids. The aspirin-first group in total, had a 39.6% decrease in subjective pain experience after giving additional nitroglycerin compared to nitroglycerin-first group. Conclusion In patients with ACS, this study found that giving nitroglycerin 10 min after aspirin was associated with a reduction in subjective pain scores, as well as a reduced need for additional nitroglycerin or opioids. Future prospective trials examining the timing of aspirin vs. nitroglycerin are needed to confirm these findings.

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Management of acute coronary syndrome in older adults (data from russian federal acute coronary syndrome registry)

Terapevticheskii arkhiv ◽

10.26442/terarkh201890367-71 ◽

2018 ◽

Vol 90 (3) ◽

pp. 67-71

Author(s):

E V Ocshepkova ◽

O V Sagaydak ◽

I E Chazova

Keyword(s):

Acute Coronary Syndrome ◽

Age Groups ◽

Younger Patients ◽

Economic Problems ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Quality Of Medical Care ◽

Current Guidelines ◽

Global Aging

The frequency of cardiovascular diseases is increasing progressively with age, and the global aging of the population poses the problem of treatment of patients of older age groups in a row with other relevant medical and socio-economic problems. Aim. In the present study was to investigate the quality of medical care for patients with acute coronary syndrome (ACS) old age and compliance of the treatment current guidelines. The data is exported from the system of the Federal register OKS. Materials and methods. Analyzed medical history 33 893 patients with ACS entered in the system registry of ACS for the period from 01.01.2016 to 31.12.2016. a comparison was made of the quality of care in patients with ACS elderly (75 years and older, n=8773) and in younger patients. Results. The results of the study showed that in patients of senile age, when compared with younger patients, comorbid conditions are significantly more often observed, as well as a significantly higher risk of hospital and 6-month death, calculated on the GRACE scale. Conclusion. Patients of senile age with ACS are almost twice less likely to undergo percutaneous coronary interventions than younger ones, which worsens the prognosis in these patients and increases mortality.

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