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
UMMS Affiliation
Center for Outcomes Research
Publication Date
2009-12-05
Document Type
Article
Subjects
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
Disciplines
Health Services Research
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.
DOI of Published Version
10.1016/j.ahj.2009.09.016
Source
Am Heart J. 2009 Dec;158(6):917-24. Link to article on publisher's site
Journal/Book/Conference Title
American heart journal
Related Resources
PubMed ID
19958857
Repository Citation
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