Related Experiment Videos

Acute clopidogrel use and outcomes in patients with non-ST-segment elevation acute coronary syndromes undergoing

Rajendra H Mehta1, Matthew T Roe, Jyotsna Mulgund

  • 1Division of Cardiology and the Duke Clinical Research Institute, Durham, North Carolina 27715, USA. mehta007@dcri.duke.edu

Journal of the American College of Cardiology
|July 18, 2006
PubMed

Insights

Clopidogrel use before coronary artery bypass grafting (CABG) in non-ST-segment elevation acute coronary syndromes (NSTE ACS) patients often occurs within 5 days. This timing is linked to increased blood transfusion needs, highlighting a gap between guidelines and practice.

Area of Science:

  • Cardiology
  • Clinical Pharmacology

Background:

  • Current adherence to guidelines for clopidogrel use in non-ST-segment elevation acute coronary syndromes (NSTE ACS) patients undergoing coronary artery bypass grafting (CABG) is not well-characterized.
  • Investigating clopidogrel's impact on postoperative transfusions is crucial for patient outcomes.

Purpose of the Study:

  • To characterize clopidogrel use patterns before CABG in NSTE ACS patients.
  • To examine the association between clopidogrel administration timing and postoperative transfusion risks.

Main Methods:

  • A cohort of 2,858 NSTE ACS patients undergoing CABG was analyzed from the CRUSADE Initiative.
  • Clopidogrel use patterns and transfusion risks were assessed based on CABG timing: early (≤5 days) versus late (>5 days) post-catheterization.

Main Results:

  • 30% of patients received clopidogrel within 24 hours of admission; 87% underwent CABG ≤5 days after treatment, contravening guidelines.
  • Early CABG (≤5 days) after clopidogrel was associated with significantly higher blood transfusion rates (65.0% vs. 56.9%) and need for ≥4 units (27.7% vs. 18.4%).
  • Delayed CABG (>5 days) showed no significant association with increased bleeding risks.

Conclusions:

  • Most NSTE ACS patients treated with clopidogrel undergo early CABG, deviating from recommended guidelines.
  • Failure to delay CABG post-clopidogrel increases transfusion requirements, necessitating a balance with potential delay impacts.
Abstract

Related Concept Videos

Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
Peripheral Artery Disease V: Postoperative Nursing Management01:23

Peripheral Artery Disease V: Postoperative Nursing Management

During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
Acute Coronary Syndrome V: Nursing Management01:26

Acute Coronary Syndrome V: Nursing Management

Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...