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 Diagnosis and Management of Acute Coronary Syndrome: What is New and Why? Insight From the 2020 European Society of Cardiology Guidelines

2020 ◽  
Vol 9 (11) ◽  
pp. 3474
Author(s):  
Paul Guedeney ◽  
Jean-Philippe Collet
Keyword(s):  
Acute Coronary Syndrome ◽  
European Society ◽  
Bleeding Risk ◽  
St Segment Elevation ◽  
P2y12 Inhibitors ◽  
Diagnosis And Management ◽  
Coronary Syndrome ◽  
St Segment ◽  
European Society Of Cardiology ◽  
Rule Out

The management of acute coronary syndrome (ACS) has been at the center of an impressive amount of research leading to a significant improvement in outcomes over the last 50 years. The 2020 European Society of Cardiology (ESC) Guidelines for the management of patients presenting without persistent ST-segment elevation myocardial infarction have incorporated the most recent breakthroughs and updates from large randomized controlled trials (RCT) on the diagnosis and management of this disease. The purpose of the present review is to describe the main novelties and the rationale behind these recommendations. Hence, we describe the accumulating evidence against P2Y12 receptors inhibitors pretreatment prior to coronary angiography, the preference for prasugrel as leading P2Y12 inhibitors in the setting of ACS, and the numerous available antithrombotic regimens based on various durations of dual or triple antithrombotic therapy, according to the patient ischemic and bleeding risk profiles. We also detail the recently implemented 0 h/1 h and 0 h/2 h rule in, rule out algorithms and the growing role of computed coronary tomography angiography to rule out ACS in patients at low-to-moderate risk.

Glycoprotein IIb/IIIa Receptor Inhibitors in Percutaneous Coronary Intervention and Acute Coronary Syndrome

2003 ◽  
Vol 37 (6) ◽  
pp. 860-875 ◽  
Author(s):  
Michael A Crouch ◽  
Jean M Nappi ◽  
Kai I Cheang
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Coronary Intervention ◽  
Data Sources ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Percutaneous Coronary

OBJECTIVE: To review the contemporary role of the glycoprotein (GYP) IIb/IIIa receptor inhibitors abciximab, eptifibatide, and tirofiban in patients undergoing percutaneous coronary intervention (PCI) and those with an acute coronary syndrome (ACS), and to provide an algorithm based on currently available evidence for specific agents. DATA SOURCES: Primary articles were identified by a MEDLINE search (1966–January 2003); references cited in these articles provided additional resources. STUDY SELECTION AND DATA EXTRACTION: All of the articles identified from data sources were considered for relevant information; this article primarily addresses large, controlled or comparative studies, and meta-analyses. DATA SYNTHESIS: The role of GYP IIb/IIIa inhibitors in patients undergoing PCI and those with ACS has progressed markedly. To date, abciximab has the most robust data in patients undergoing PCI, particularly high-risk individuals. In PCI patients with lower risk (e.g., elective stenting), eptifibatide is a reasonable first-line option. Data do not support tirofiban for routine use in patients undergoing PCI. For individuals with signs and symptoms of ACS, specifically unstable angina or non–ST-segment elevation myocardial infarction (MI), eptifibatide or tirofiban is recommended in high-risk patients when a conservative approach is used (PCI is not planned). Abciximab is not recommended in this situation. In patients with ST-segment elevation MI (STEMI), abciximab is the only GYP IIb/IIIa inhibitor evaluated in large, well-designed investigations. For medical management in combination with a fibrinolytic agent, the role of abciximab remains unclear. For patients undergoing primary PCI for the management of STEMI, the available evidence supports the use of abciximab, albeit further investigation is warranted. CONCLUSIONS: The role of GYP IIb/IIIa inhibitors in clinical cardiology continues to evolve. Choice of the agent depends on situation of use, patient-specific characteristics and risk stratification, and, in the case of ACS, chosen management strategy (medical management or intervention).

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

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.

scholarly journals ASSESSMENT OF MYOCARDIAL REPERFUSION QUALITY IN PATIENTS WITH ACUTE CORONARY SYNDROME AND ST SEGMENT ELEVATION, BASED ON THE CRITERIA BY THE AMERICAN COLLEGE OF CARDIOLOGY/AMERICAN HEART ASSOCIATION

2013 ◽  
Vol 12 (5) ◽  
pp. 40-44 ◽  
Author(s):  
O. M. Posnenkova ◽  
A. R. Kiselev ◽  
V. I. Gridnev ◽  
Yu. V. Popova ◽  
P. Ya. Dovgalevskyi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Primary Pci ◽  
Inclusion Criteria ◽  
Myocar Dial ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Aim. To use the criteria by the American College of Cardiology/American Heart Association (ACC/AHA), in order to assess the quality of myocar-dial reperfusion in Russian patients with acute coronary syndrome (ACS) and ST segment elevation (STE-ACS).Material and methods. We analysed the clinical data of 25682 patients with STE-ACS, who were treated (2010–2011) in Russian hospitals participating in the Russian ACS Registry. The following ACC/AHA indicators (2008) were used: “time to thrombolysis” — the percentage of STE-ACS patients who received thrombolysis within 30 minutes after admission; “time to primary percutaneous coronary intervention (PCI)” — the per-centage of STE-ACS patients in whom primary PCI started within 90 minutes after admission; and “reperfusion” — the percentage of STE-ACS patients who underwent any reperfusion intervention within 12 hours after the chest pain onset.Results. Among 25682 STE-ACS patients, any reperfusion intervention (PCI and/or thrombolysis, in any order) were performed in 12043 (46,9%). Among 7437 STE-ACS patients who underwent thrombolysis, 5119 (69%) met the inclusion criteria. In this group, the indicator “time to thrombolysis” was met in 3342 patients (65,3%). Among 5405 STEACS patients who underwent PCI, 3993 (73,9%) met the inclusion criteria. In these patients, the indicator “time to primary PCI” was met in 2797 (70%). Finally, among 25135 (97,9%) patients with STE-ACS who were included in the analyses, the indicator “reperfusion” was met in 9800 (38,9%).Conclusion. The main problem of the health care for Russian patients with STE-ACS is the limited reperfusion coverage. However, the reperfusion quality could be regarded as satisfactory. 

The Role of Serum Bilirubin Levels in Predicting Troponin Positivity in Non-ST-Segment Elevation Acute Coronary Syndrome

Angiology ◽  
2016 ◽  
Vol 68 (5) ◽  
pp. 414-418 ◽  
Author(s):  
Mustafa Ozturk ◽  
Lutfu Askın ◽  
Emrah Ipek ◽  
Selami Demirelli ◽  
Oguzhan Ekrem Turan ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Serum Bilirubin ◽  
Acute Chest Pain ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Elevation Acute Coronary Syndrome ◽  
Group 2 ◽  
Group 1

Data are scant regarding serum bilirubin levels in non-ST-segment elevation acute coronary syndrome (NSTE-ACS). In this study, we evaluated the role of serum bilirubin levels in NSTE-ACS. We enrolled 782 patients who presented to the emergency department with acute chest pain. Patients were divided into 2 groups based on the troponin positivity. Patients with NSTE-ACS who had troponin positivity were included in group 1 (n = 382), and group 2 consisted of the control patients (n = 400). Direct bilirubin (DB) levels (group 1: 0.31 ± 0.37 mg/dL, group 2: 0.20 ± 0.25 mg/dL, P < .001) and total bilirubin (TB) levels (group 1: 0.78 ± 0.56 mg/dL, group 2: 0.62 ± 0.45 mg/dL, P < .001) were significantly higher in group 1. There was a significant and moderate correlation between serum bilirubin levels and admission troponin values ( r = .34, P < .001 for TB and r = .42, P < .001 for DB). These results show that serum bilirubin levels were associated with troponin positivity in patients with NSTE-ACS.

scholarly journals Role of clopidogrel in addition to aspirin in the prevention of recurrent ischaemic events in acute coronary syndrome with ST-segment elevation

2018 ◽  
Vol 7 (8) ◽  
pp. 1506
Author(s):  
Vasavi Patra ◽  
Victor Emmanuel Ulchala
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Group Versus ◽  
Loading Dose ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Urgent Revascularisation ◽  
Group 2

Background: Studies regarding the efficacy of Aspirin alone versus combination of Aspirin and Clopidogrel in patients with Unstable Angina are many. But, studies on the comparative role of Aspirin alone versus Aspirin plus Clopidogrel in the background of Acute Coronary Syndrome (ACS) with ST segment elevation myocardial infarction (STEMI) were very few, at the time of starting of this study. Keeping this in mind present study was conducted to compare the efficacy and safety of Aspirin alone with combination of aspirin plus Clopidogrel in prevention of events in Acute Coronary Syndrome with ST segment elevation myocardial infarction.Methods: Patients who are admitted to intensive coronary care unit within 12hrs after the onset of symptoms and whose diagnosis as ACS with ST segment elevation has been established were included in this study. Patients in group 1 received 325 mg of aspirin as loading dose, followed by 150 mg once daily. Patients in group 2 received a combination of aspirin and Clopidogrel 325 and 300 mg, respectively, as loading dose, followed by 150 mg of aspirin and 75 mg of Clopidogrel daily. All the patients received a fibrinolytic agent. Treatment response was weighed against the primary and secondary expected outcomes.Results: Addition of Clopidogrel to Aspirin resulted in significant reduction in severe ischaemia not requiring urgent revascularisation i.e.; 32% in Aspirin alone group versus 10% in Aspirin plus Clopidogrel group and recurrent angina with no ECG changes i.e.; 42% in aspirin alone group versus 20% in Aspirin plus Clopidogrel group. Similarly, there was an improvement in ejection fraction at the end of one month i.e.; 0.3% in Aspirin alone group versus 1.85% in Aspirin plus Clopidogrel group.Conclusions: This study demonstrates the benefit of adding Clopidogrel to Aspirin for myocardial infarction with ST-segment elevation. Treatment with a loading dose of 300mg of Clopidogrel followed by a daily dose of 75mg, in addition to aspirin, resulted in significant improvement in the secondary efficacy related outcomes in patients with acute coronary syndrome with ST-segment elevation.

scholarly journals Antithrombotic PreTreatment and Invasive Strategies in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome

2020 ◽  
Vol 9 (8) ◽  
pp. 2578 ◽  
Author(s):  
Cyril Camaro ◽  
Peter Damman
Keyword(s):  
Acute Coronary Syndrome ◽  
Optimal Timing ◽  
Mortality Benefit ◽  
Antithrombotic Treatment ◽  
Invasive Strategy ◽  
St Segment Elevation ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome ◽  
St Segment ◽  
Elevation Acute Coronary Syndrome

In the current era, the antithrombotic treatment of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) includes standard aspirin, and one of the potent P2Y12 inhibitors ticagrelor or prasugrel. The optimal timing of ticagrelor has not been adequately studied, while prasugrel is only recommended after coronary angiography prior to PCI. The invasive strategy, including indication and timing of angiography, depends on risk stratification and a mortality benefit has been shown in selected high-risk NSTE-ACS undergoing early (<24 h) intervention.

scholarly journals MIF mRNA Expression and Soluble Levels in Acute Coronary Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Emmanuel Valdés-Alvarado ◽  
Yeminia Valle ◽  
José Francisco Muñoz-Valle ◽  
Ilian Janet García-Gonzalez ◽  
Angelica Valdez-Haro ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Mrna Expression ◽  
Clinical Manifestations ◽  
Serum Levels ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Myocardial Infraction

Acute coronary syndrome (ACS) describes any condition characterized by myocardial ischaemia and reduction in blood flow. The physiopathological process of ACS is the atherosclerosis where MIF operates as a major regulator of inflammation. The aim of this study was to assess the mRNA expression of MIF gene and its serum levels in the clinical manifestations of ACS and unrelated individuals age- and sex-matched with patients as the control group (CG). All samples were run using the conditions indicated in TaqMan Gene Expression Assay protocol. Determination of MIF serum levels were performed by enzyme-linked immunosorbent assay and MIF ELISA Kit. ST-segment elevation myocardial infraction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) showed 0.8 and 0.88, respectively, less expression of MIF mRNA with regard to CG. UA and STEMI presented more expression than NSTEMI 5.23 and 0.68, respectively. Otherwise, ACS patients showed significant higher MIF serum levels (p=0.02) compared with CG. Furthermore, the highest soluble levels of MIF were presented by STEMI (11.21 ng/dL), followed by UA (10.34 ng/dL) and finally NSTEMI patients (8.75 ng/dL); however, the differences were not significant. These novel observations further establish the process of MIF release after cardiovascular events and could support the idea of MIF as a new cardiac biomarker in ACS.

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