Acute Coronary Syndrome: Focus on Antiplatelet Therapy

2016 ◽  
Vol 36 (1) ◽  
pp. 15-27 ◽  
Author(s):  
Rodel V. Bobadilla
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Clinical Decision Making ◽  
Treatment Guidelines ◽  
Heart Association ◽  
Clinical History ◽  
Clinical Decision ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

The American Heart Association/American College of Cardiology in 2014 published a focused update of the 2007 and 2012 guidelines for non–ST-segment elevation acute coronary syndrome (NSTE-ACS). The management of ST-segment elevation myocardial infarction (STEMI) is described in a separate guideline published in 2013. The focused updates to the guidelines contain updated recommendations for dual antiplatelet therapy, including use of the P2Y12 inhibitor ticagrelor, which was recently approved by the Food and Drug Administration. Nurses caring for patients with acute coronary syndrome must have a good understanding of the current treatment guidelines for such patients, to help ensure delivery of evidence-based care. This review article uses a case study–based approach to describe how the new guidelines affect clinical decision making when choosing appropriate antiplatelet therapy for patients with NSTE-ACS or STEMI, depending on the patient’s clinical history and presenting characteristics.

Use of Glycoprotein IIb/IIIa Inhibitors in the Modern Era of Acute Coronary Syndrome Management: A Survey of Cardiovascular Clinical Pharmacists

2019 ◽  
pp. 089719001987238
Author(s):  
Craig J. Beavers ◽  
Douglas L. Jennings
Keyword(s):  
Acute Coronary Syndrome ◽  
Heart Association ◽  
Research Network ◽  
St Segment Elevation ◽  
P2y12 Inhibitors ◽  
Clinical Pharmacists ◽  
Coronary Syndrome ◽  
St Segment ◽  
Myocardial Infraction

Evidence for the use of glycoprotein IIb/IIIa inhibitors (GPIs) in the management of acute coronary syndrome (ACS) is from the era of either limited utilization of P2Y12 inhibitors or prior the introduction of more potent P2Y12 inhibitors. This leads to divergent opinions regarding the role of these agents in contemporary practice. This study sought the opinion of cardiovascular clinical pharmacists regarding the role of GPIs in the modern of ACS management. A 13-question survey was created and distributed from June 2018 to July 2018 via the American College of Clinical Pharmacy’s Cardiology Practice and Research Network e-mail listserv. The survey consisted of questions regarding the ideal use of GPIs in ACS management, preferred agent selection, and rational for selection. All results were analyzed with descriptive statistics. There were a total 69 responses of 1175 (response rate 5.9%). The majority felt there was still a role for GPI in accordance to the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for ST-segment elevation myocardial infarction (65.2%), with eptifibatide being preferred (55.1%). For non-ST-segment myocardial infraction (NSTEMI), only 49.3% felt role of GPI was in line with the ACC/AHA guidelines, but a notable number of respondents felt GPIs were only indicated in NSTEMI patients for bailout or thrombotic complications (18.8%). A majority (56.5%) felt GPIs could be used as an alternative for cangrelor when bridging. The decision to use one agent over another were efficacy data, cost, and pharmacokinetic profile.

scholarly journals Old and New Players in Oral Antiplatelet Therapy in Treatment of Acute Coronary Syndrome

1970 ◽  
Vol 1 (1) ◽  
pp. 49-55
Author(s):  
SC Kohli
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Antiplatelet Drugs ◽  
Conservative Strategy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Oral antiplatelet therapy plays an important role in treating patients with acute coronary syndrome (ACS), including patients with unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI) and patients with ST-segment elevation myocardial infarction (STEMI). All antiplatelet drugs in addition to inhibiting acute arterial thrombosis have danger of interfering with the physiologic role of platelet hemostasis. Bleeding is a major factor in evaluating the utility of available and upcoming antiplatelet drugs and their combination regimes. The role of anti platelet agents in the treatment of ACS has undergone significant changes over the past several years. Aspirin, thienopyridines, and glycoprotein (GP) IIb/IIIa inhibitors are now standard parts of the treatment of STEMI, NSTEMI and UA whether an early invasive or an initial conservative strategy is chosen. Antiplatelet drugs have an important role in secondary prevention in the patients of ischaemic heart disease. Keywords: Acute Coronary Syndrome; antiplatelet therapy; thienopyridines. DOI: http://dx.doi.org/10.3126/njms.v1i1.5799   Nepal Journal of Medical Sciences. 2012; 1(1): 49-55

scholarly journals Timing of dual antiplatelet therapy in acute coronary syndrome: a problem of coronary artery bypass grafting accessibility for patients

2020 ◽  
Vol 25 (8) ◽  
pp. 3812
Author(s):  
T. S. Golovina ◽  
Yu. N. Neverova ◽  
R. S. Tarasov
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Antiplatelet Therapy ◽  
Coronary Artery Bypass ◽  
Dual Antiplatelet Therapy ◽  
Artery Bypass ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Elevation Acute Coronary Syndrome

The feasibility of dual antiplatelet therapy as early as possible in patients with ST-segment elevation acute coronary syndrome, where percutaneous coronary intervention is recommended, has been proven: it improves treatment outcomes by reducing the risk of adverse ischemic events, including stent thrombosis and myocardial infarction.This article provides a detailed analysis of the evidence data and current recommendations on the validity and timing of dual antiplatelet therapy for acute coronary syndrome. The emphasis is made on the controversy regarding the early dual antiplatelet therapy in non-ST-segment elevation acute coronary syndrome. The rationale for using dual antiplatelet therapy only after coronary angiography and determining the revascularization strategy is described, which should increase the accessibility of coronary artery bypass graft surgery for patients.

scholarly journals Acute Coronary Syndrome, Antiplatelet Therapy, and Bleeding: A Clinical Perspective

2020 ◽  
Vol 9 (7) ◽  
pp. 2064
Author(s):  
Gregorio Tersalvi ◽  
Luigi Biasco ◽  
Giacomo Maria Cioffi ◽  
Giovanni Pedrazzini
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Clinical Decision Making ◽  
Treatment Strategies ◽  
Clinical History ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Coronary Syndrome

Inhibition of platelet function by means of dual antiplatelet therapy (DAPT) is the cornerstone of treatment of acute coronary syndrome (ACS). While preventing ischemic recurrences, inhibition of platelet function is clearly associated with an increased bleeding risk, a feared complication that may lead to significant morbidity and mortality. Since bleeding risk management is intrinsically associated with therapeutic adjustments undertaken during the whole clinical history of patients with acute coronary syndrome, single decisions taken from the very first day to years of follow-up might be decisive. This review aims at providing a clinically oriented, patient-tailored approach in reducing the risk and manage bleeding complications in ACS patients treated with DAPT. The steps in clinical decision making from the day of ACS to follow-up are analyzed. New treatment strategies to enhance the safety of DAPT are also described.

scholarly journals Reflection on Clinical Decision Science: Clinical Decision Science suggests different research questions need to be asked related to informed consent

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
John K Geddes
Keyword(s):  
Acute Coronary Syndrome ◽  
Informed Consent ◽  
Clinical Decision ◽  
Research Literature ◽  
Decision Science ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
New Directions ◽  
Research Questions

The author examines the literature relating to informed consent for early cardiac catheterization to treat Non-ST-segment elevation acute coronary syndrome, and considers whether Clinical Decision Science might provide new directions for applying the clinical research literature.

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