Adjuvant antithrombotic therapy in ST-elevation myocardial infarction: Contemporaneous Portuguese cross-sectional
Daniel Caldeira1, Hélder Pereira2, Ana Marques2
1Cardiology Department, Hospital Garcia de Orta, Almada, Portugal; Laboratório de Farmacologia Clínica e Terapêutica, CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Portugal.
Insights
In 2016, nearly all ST-elevation myocardial infarction (STEMI) patients in Portugal received aspirin and 76% got dual antiplatelet therapy. Unfractionated heparin was the most common anticoagulant, with limited use of newer agents.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Standard care for ST-elevation myocardial infarction (STEMI) involves network activation, adjuvant medical therapy, and primary percutaneous coronary intervention (PCI).
- Antithrombotic therapy, comprising antiplatelet and anticoagulant agents, is crucial for optimizing clinical outcomes in STEMI patients undergoing PCI.
Purpose of the Study:
- To describe current real-world patterns of antithrombotic treatment use in Portugal for STEMI patients undergoing primary PCI.
Main Methods:
- An observational, retrospective, cross-sectional study was conducted using data from 2016.
- Data were retrieved from two national registries: the Portuguese Registry on Acute Coronary Syndromes (ProACS) and the Portuguese Registry on Interventional Cardiology (PRIC).
- Information on oral antiplatelet and procedural intravenous antithrombotic drugs was collected.
Main Results:
- In 2016, 534 STEMI patients were enrolled in ProACS and 2625 in PRIC.
- Aspirin was administered to 99.6% of patients, and 75.6% received dual antiplatelet therapy (primarily clopidogrel).
- Unfractionated heparin (UFH) was used in 78% of cases, while GP IIb/IIIa inhibitors were used in 11.6% and low molecular weight heparin in 2%.
Conclusions:
- In 2016, almost all STEMI patients in Portugal received aspirin, with 76% on dual antiplatelet therapy, predominantly clopidogrel.
- GP IIb/IIIa inhibitors were infrequently used, and UFH was the most common parenteral anticoagulant.
- The study identified limitations due to missing data in the registries.
Introduction:
The standard of care for acute ST-elevation myocardial infarction (STEMI) includes the activation of a STEMI care network, the administration of adjuvant medical therapy, and reperfusion through primary percutaneous coronary intervention (PCI). While primary PCI is nowadays the first option for the treatment of patients with STEMI, antithrombotic therapy, including antiplatelet and anticoagulant agents, is the cornerstone of pharmacological treatment to optimize their clinical outcomes.
Objective:
The aim of this study was to describe contemporaneous real-world patterns of use of antithrombotic treatments in Portugal for STEMI patients undergoing primary PCI.
Methods:
An observational, retrospective cross-sectional study was performed for the year 2016, based on data from two national registries: the Portuguese Registry on Acute Coronary Syndromes (ProACS) and the Portuguese Registry on Interventional Cardiology (PRIC). Data on oral antiplatelet and procedural intravenous antithrombotic drugs were retrieved.
Results:
In 2016, the ProACS enrolled 534 STEMI patients treated with primary PCI, while the PRIC registry reported data on 2625 STEMI patients. Of these, 99.6% were treated with aspirin and 75.6% with dual antiplatelet therapy (mostly clopidogrel). GP IIb/IIIa inhibitors (mostly abciximab) were used in 11.6% of cases. Heparins were used in 80% of cases (78% unfractionated heparin [UFH] and 2% low molecular weight heparin). None of the patients included in the registry were treated with cangrelor, prasugrel or bivalirudin. Missing data are one of the main limitations of the registries.
Conclusions:
In 2016, according to data from these national registries, almost all patients with STEMI were treated with aspirin and 76% with dual antiplatelet agents, mostly clopidogrel. GP IIb/IIIa inhibitors were used in few patients, and UFH was the most prevalent parenteral anticoagulant drug.
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