Background Due to the inclusion of new antiplatelet treatment in the pharmacotherapeutic guide, the Cardiology Department developed a protocol for management of antiplatelet treatment in Acute Coronary Syndrome (ACS) in May 2013.
Purpose To check whether the new antiplatelet drugs ticagrelor (T) and prasugrel (P) were being used in accordance with a protocol for managing antiplatelet treatment in ACS.
Material and methods Prospective, observational study of patients receiving T or P. Study period: October 2013–March 2014. In ACS patients with ST-segment elevation (STEACS) the protocol required the location of the myocardial area affected, increased ST visualisation in at least a 3-lead electrocardiogram (ECG), and a score of ≥3 on the TIMI scale. Treatment of patients with non-ST-segment elevation SCA (NST-ACS) required a TIMI score ≥3. Sex, age, weight, presence of diabetes mellitus (DM), history of stroke/transient ischaemic attack (TIA), kidney failure (KF), pharmacotherapeutic history and prior antiplatelet treatment were recorded. A database was created with the variables described.
Results 92 patients were included, 77 males (83.69%), mean age 61.92 ± 10.73 years. 27 patients (29.35%) received ticagrelor and 65 (70.65%) prasugrel. In 12 patients T and P were the usual treatment and they were not considered. Diagnosis: 57/80 (71.25%) STEACS; and 23/80 (28.75%) NST-ACS. Of the 57 patients with STEACS, the infarcted area was anterior/anterolateral in 22 patients, inferior/inferoposterior in 33 and lateral in 2. ST-segment elevation in ≥3 ECG leads (84.21%) was observed in 48 patients. TIMI ≥3 in 44 patients (77.20%). Of the 23 patients with NST-ACS, TIMI score was ≥3 in 20 (86.95%). No patients had stroke/TIA background. However, 18.75% and 1.25% had DM and KF respectively. The total percentage of appropriate use of T and P was 91.25%, reaching 94.55% for P and 84.00% for T. The reasons for non-compliance with the protocol were: in the case of P, not meeting the infarct area (1 patient) or no diagnosis of NST-ACS (1 patient); and in the case of T: no diagnosis of STEACS (2 patients) or NST-ACS with TIMI <3 (1 patient).
Conclusion The use of this management protocol has facilitated both medical prescription and pharmaceutical validation of antiplatelet treatment in patients with ACS.
References and/or Acknowledgements No conflict of interest.
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