Naslov
Anticoagulation therapy selection and invasive strategy in non-ST elevation acute coronary syndromes: recommendations and everyday practice.

Autori
Hadžibegović, Irzal ; Prvulović, Đeiti ; Vujeva, Božo ; Gabaldo, Krešimir

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, neobjavljeni rad, stručni

Skup
VI. kongres kardiologa i angiologa BiH

Mjesto i datum
Tuzla, Bosna i Hercegovina, 30.05.2013. - 01.06.2013

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
anticoagulation; NSTEMI; acute coronary syndrome

Sažetak
Introduction: Latest 2011 non-ST elevation acute coronary syndromes (NSTE-ACS) management guidelines indicated that all patients with NSTE- ACS should be put on anticoagulation drugs irrespective of treatment strategy. In addition, the guidelines gave clear recommendations on patient selection for urgent invasive, invasive or conservative management. There were no recommendations on preferred anticoagulation treatment regarding the timeliness of invasive procedure. We analyzed our 1-year data on anticoagulation therapies for NSTE-ACS in relation to invasive management selection, timeliness of invasive strategy, complications and treatment outcomes. Patients and methods: Data for 186 patients with NSTE-ACS treated in the the coronary care unit (CCU) in General hospital Slavonski Brod, Croatia form Jan 2011 to Dec 2011 were analyzed. All patients received dual antiplatelet therapy according to guidelines. Mixing of anticoagulants was discouraged. Anticoagulation therapy selection was analyzed in regard to invasive or conservative strategy, as well as to the timeliness of invasive procedure. Treatment strategies and outcomes and among patients treated with different anticoagulation agents were analyzed and compared. Results: In all, 123 (66%) patients were treated invasively, out of which 66% underwent angiography within the first 72 hours. Beside 3% of patients receiving UFH, 59% of patients received low molecular weight heparin (LMWH), whereas fondaparinux was administered in 38% of patients. There were significantly more patients treated with LMWH than with fondaparinux in the early invasive strategy group (chi square, P<0, 05). Proportion of patients treated with fondaparinux who did not undergo coronary angiography within the same hospital stay was higher than in LMWH treated patients. There were no differences in revascularization strategies after coronarography regarding the chosen anticoagulation therapy. In general, in-hospital mortality and major bleeding event rate was low, 3, 8% and 4, 3% respectively, with no differences regarding the selection of anticoagulation therapy. Conclusions: Although the guidelines gave slight preference to fondaparinux, everyday practice in our hospital showed that LMWH was preferred agent, particularly in patients selected for early invasive strategy. It seems reasonable to evaluate differences among various hospitals and tailor the guidelines according to local practice and individual patient risk profile.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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