Background and Importance The dual antiplatelet therapy(DAPT) consisting of acetylsalicylic acid plus one P2Y12 platelet receptor inhibitor represents the first line to treat patients with diagnosis of acute coronary syndrome (ACS).
Aim and Objectives To review the DAPT prescribed to patients with ACS admitted in a third level hospital and to assess their adequacy grade to the European guidelines of cardiology (ESC).
Material and Methods Observational and retrospective study done between January-June 2022 where data for patients with ACS diagnosis: unstable angina(UA) or myocardial acute infarction with and without ST elevation (STEMI, NSTEMI) have been collected. Studied variables were demographic and clinical information (diagnostic, treatment, cardiovascular risk factors(CVRF)). For each patient ischemic and haemorrhagic risk have been calculated (using GRACE and CRUSADE score). Patients with 3 or more of the CVRF described have been considered fragile patients. ESC guidelines established the appropriate DAPT for each patient according to the ACS's type and patient’s ischemic-haemorrhagic risk. Adequacy was assessed in terms of compliance or non-compliance with these recommendations.
Data were exported from medical history thanks to SAP® informatics’ tool and Silicon® electronic prescription program. Statistic analysis was made by Stata.v.15.0®. Qualitative variables were expressed in percentages and absolute frequencies. Quantitative ones like average ± standard deviation.
Results A total of 95 patients were diagnosed with ACS 74,74% (71) of which were men with an average age of 64,38 ± 12,77 years, the 7,37% (7) with UA, 44,21% (42) NSTEMI and 48,42% (46) STEMI. All were under treatment with DAPT and moreover the 21,05% (20) were anticoagulated after percutaneous coronary intervention. The 51,58% (49) were low, 33,68% (32) medium and 14,74% (14) high ischemic risky patients. Regarding the bleeding risk the 53,86% (51) were low, 23,16% (22) medium and 23,16% (22) high.
The 37,89% (36) of the prescribed treatments weren’t complying with the recommended DAPT in ESC guidelines according to ACS's type and patient’s risk factors. By diagnosis, in 42,85% (3/7) of UA patients, 42,85% (18/42) of NSTEMI and 30,43% (14/46) of STEMI the prescriptions did not conform to guidelines.
Conclusion and Relevance Percentage of non-adequacy of prescribed DAPT to recent published ESC guidelines is considerable, leading to disparity of criteria with guidelines and between professionals and possible treatment's inequity between patients. Future studies could explore the importance of pharmacist integration and validation to avoid reported discrepancies.
Conflict of Interest No conflict of interest.
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