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
dc.contributor.author | Banihashemi, Behnam | |
dc.contributor.author | Goodman, Shaun G. | |
dc.contributor.author | Yan, Raymond T. | |
dc.contributor.author | Welsh, Robert C. | |
dc.contributor.author | Meta, Shamir R. | |
dc.contributor.author | Montalescot, Gilles | |
dc.contributor.author | Kornder, Jan | |
dc.contributor.author | Wong, Graham C. | |
dc.contributor.author | Gyenes, Gabor | |
dc.contributor.author | Steg, Phillippe Gabriel | |
dc.contributor.author | Yan, Andrew T. | |
dc.contributor.author | Global Registry of Acute Coronary Events (GRACE/GRACE2) Investigators | |
dc.date | 2022-08-11T08:08:09.000 | |
dc.date.accessioned | 2022-08-23T15:44:21Z | |
dc.date.available | 2022-08-23T15:44:21Z | |
dc.date.issued | 2009-12-05 | |
dc.date.submitted | 2011-10-20 | |
dc.identifier.citation | Am Heart J. 2009 Dec;158(6):917-24. <a href="http://dx.doi.org/10.1016/j.ahj.2009.09.016">Link to article on publisher's site</a> | |
dc.identifier.issn | 0002-8703 (Linking) | |
dc.identifier.doi | 10.1016/j.ahj.2009.09.016 | |
dc.identifier.pmid | 19958857 | |
dc.identifier.uri | http://hdl.handle.net/20.500.14038/27296 | |
dc.description.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. | |
dc.language.iso | en_US | |
dc.relation | <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=19958857&dopt=Abstract">Link to Article in PubMed</a> | |
dc.relation.url | http://dx.doi.org/10.1016/j.ahj.2009.09.016 | |
dc.subject | 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 | |
dc.subject | Health Services Research | |
dc.title | 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 | |
dc.type | Journal Article | |
dc.source.journaltitle | American heart journal | |
dc.source.volume | 158 | |
dc.source.issue | 6 | |
dc.identifier.legacycoverpage | https://escholarship.umassmed.edu/cor_grace2/9 | |
dc.identifier.contextkey | 2305122 | |
html.description.abstract | <p><h4>BACKGROUND:</h4></p> <p>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). <h4>METHODS:</h4></p> <p>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). <h4>RESULTS:</h4></p> <p>Overall, 3,893 patients (67.1%) received early ( <h4>CONCLUSIONS:</h4></p> <p>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.</p> | |
dc.identifier.submissionpath | cor_grace2/9 | |
dc.contributor.department | Center for Outcomes Research | |
dc.source.pages | 917-24 |