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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Goodman, Shaun G.
Yan, Raymond T.
Welsh, Robert C.
Meta, Shamir R.
Wong, Graham C.
Steg, Phillippe Gabriel
Yan, Andrew T.
Global Registry of Acute Coronary Events (GRACE/GRACE2) Investigators
UMass Chan AffiliationsCenter for Outcomes Research
Document TypeJournal Article
KeywordsAcute 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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AbstractBACKGROUND: 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.
SourceAm Heart J. 2009 Dec;158(6):917-24. Link to article on publisher's site
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/27296
Related ResourcesLink to Article in PubMed