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
Center for Outcomes Research
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
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).
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).
Overall, 3,893 patients (67.1%) received early (
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.
DOI of Published Version
Am Heart J. 2009 Dec;158(6):917-24. Link to article on publisher's site
American heart journal
Banihashemi B, Goodman SG, Yan RT, Welsh RC, Meta SR, Montalescot G, Kornder J, Wong GC, Gyenes G, Steg PG, Yan AT, Global Registry of Acute Coronary Events (GRACE/GRACE2) Investigators. (2009). 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. GRACE2 (Expanded GRACE) Publications. https://doi.org/10.1016/j.ahj.2009.09.016. Retrieved from https://escholarship.umassmed.edu/cor_grace2/9