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    Underutilization of clopidogrel and glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute coronary syndrome patients: the Canadian global registry of acute coronary events (GRACE) experience

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    Authors
    Banihashemi, Behnam
    Goodman, Shaun G.
    Yan, Raymond T.
    Welsh, Robert C.
    Meta, Shamir R.
    Montalescot, Gilles
    Kornder, Jan
    Wong, Graham C.
    Gyenes, Gabor
    Steg, Phillippe Gabriel
    Yan, Andrew T.
    Global Registry of Acute Coronary Events (GRACE/GRACE2) Investigators
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    UMass Chan Affiliations
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2009-12-05
    Keywords
    Acute Coronary Syndrome; Aged; Canada; Drug Utilization; Female; Guideline Adherence; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Prospective Studies; Registries; Retrospective Studies; Ticlopidine
    Health Services Research
    
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    Link to Full Text
    http://dx.doi.org/10.1016/j.ahj.2009.09.016
    Abstract
    BACKGROUND: There are limited contemporary data on the early use of clopidogrel or glycoprotein (Gp) IIb/IIIa inhibitors, alone versus combination therapies, in non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS: This study included 5,806 Canadian NSTE-ACS patients with elevated cardiac biomarker and/or ST deviation on presentation in the prospective GRACE between 2003-2007. We stratified the study population according to the management strategy (non-invasive vs invasive) and into low-(GRACE risk score or=141). RESULTS: Overall, 3,893 patients (67.1%) received early ( CONCLUSIONS: In this contemporary NSTE-ACS population, both clopidogrel and GpIIb/IIIa inhibitors were targeted toward patients treated with an invasive strategy but paradoxically toward the lower-risk group. In particular, clopidogrel appeared to be underused among conservatively managed patients despite its proven efficacy, whereas GpIIb/IIIa inhibitors were administered to only a minority of the high-risk patients with elevated cardiac biomarkers. Our findings emphasize the ongoing need to promote the optimal use of evidence-based antiplatelet therapies among high-risk patients with NSTE-ACS.
    Source
    Am Heart J. 2009 Dec;158(6):917-24. Link to article on publisher's site
    DOI
    10.1016/j.ahj.2009.09.016
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27296
    PubMed ID
    19958857
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ahj.2009.09.016
    Scopus Count
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    GRACE2 (Expanded GRACE) Publications

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