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, BehnamGoodman, 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
UMass Chan Affiliations
Center for Outcomes ResearchDocument Type
Journal ArticlePublication Date
2009-12-05Keywords
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; TiclopidineHealth Services Research
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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 siteDOI
10.1016/j.ahj.2009.09.016Permanent Link to this Item
http://hdl.handle.net/20.500.14038/27296PubMed ID
19958857Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.ahj.2009.09.016