Global patterns of use of antithrombotic and antiplatelet therapies in patients with acute coronary syndromes: Insights from the Global Registry of Acute Coronary Events (GRACE)
Identifieur interne : 00B174 ( Main/Exploration ); précédent : 00B173; suivant : 00B175Global patterns of use of antithrombotic and antiplatelet therapies in patients with acute coronary syndromes: Insights from the Global Registry of Acute Coronary Events (GRACE)
Auteurs : Andrzej Budaj [Pologne] ; David Brieger [Australie] ; Gabriel Steg [France] ; Shaun G. Goudman [Canada] ; Omar H. Dabbous [États-Unis] ; Keith A. A. Fox [Royaume-Uni] ; Alvaro Avezum [Brésil] ; Christopher P. Cannon [États-Unis] ; Tomasz Mazurek [Pologne] ; Marcus D. Flather [Royaume-Uni] ; Frans Van De Werf [Belgique]Source :
- The American heart journal [ 0002-8703 ] ; 2003.
Descripteurs français
- Pascal (Inist)
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- topic : Homme.
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Abstract
Background Many agents are available to treat acute coronary syndromes (ACS), yet limited information is available about their use from a multinational perspective. The objective of this report was to describe patterns of use of antithrombotic and antiplatelet therapies in patients with the spectrum of ACS through the use of data from the Global Registry of Acute Coronary Events (GRACE). Methods Data from 12,665 patients with ACS were analyzed. Baseline characteristics, clinical presentation, and medication use were compared. Regional differences in the administration of antiplatelet and antithrombotic therapies were analyzed. Multivariable logistic regression was implemented to determine independent variables indicating the use of various hospital therapies. Results Overall, unfractionated heparin was used in 57% of patients and low-molecular-weight heparin in 47% (P < .0001). More than 90% of patients received aspirin, but approximately 13% were not discharged on aspirin. Overall, 30% of patients received thienopyridines (with percutaneous coronary intervention [PCI] in 79%). Of those who did not receive aspirin, 31% received thienopyridines. Intravenous glycoprotein inhibitors were given to 17% of patients. Among those treated with PCI, only 47% received glycoprotein inhibitors, and 21% of those given glycoprotein inhibitors did not undergo PCI. Significant geographic variation was apparent in the use of unfractionated heparin, low-molecular-weight heparin, thienopyridines, and glycoprotein inhibitors. Conclusions Despite the availability of guidelines, striking geographic and practice variations are apparent in the use of antithrombotic and antiplatelet therapies. There remains significant room for improvement in the use of these therapies in patients with ACS, which should lead to improvement in care and outcomes.
Affiliations:
- Australie, Belgique, Brésil, Canada, France, Pologne, Royaume-Uni, États-Unis
- Angleterre, Grand Londres, Nouvelle-Galles du Sud, Ontario, Écosse, État de São Paulo, Île-de-France
- Londres, Paris, Sydney, São Paulo, Toronto, Édimbourg
- Université de Toronto
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Goudman</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Canadian Heart Research Center and St Michael's Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>4 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Dabbous, Omar H" sort="Dabbous, Omar H" uniqKey="Dabbous O" first="Omar H." last="Dabbous">Omar H. Dabbous</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>University of Massachusetts Medical School</s1><s2>Worcester, Mass</s2><s3>USA</s3><sZ>5 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Fox, Keith A A" sort="Fox, Keith A A" uniqKey="Fox K" first="Keith A. A." last="Fox">Keith A. A. Fox</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>The Royal Infirmary of Edinburgh</s1><s2>Edinburgh</s2><s3>GBR</s3><sZ>6 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Édimbourg</settlement><region type="country">Écosse</region></placeName></affiliation></author><author><name sortKey="Avezum, Alvaro" sort="Avezum, Alvaro" uniqKey="Avezum A" first="Alvaro" last="Avezum">Alvaro Avezum</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>CTI-A Hospital Albert Einstein</s1><s2>São Paulo</s2><s3>BRA</s3><sZ>7 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Cannon, Christopher P" sort="Cannon, Christopher P" uniqKey="Cannon C" first="Christopher P." last="Cannon">Christopher P. Cannon</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Brigham and Women's Hospital</s1><s2>Boston, Mass</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Brigham and Women's Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Mazurek, Tomasz" sort="Mazurek, Tomasz" uniqKey="Mazurek T" first="Tomasz" last="Mazurek">Tomasz Mazurek</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Postgraduate Medical School, Grochowski Hospital</s1><s2>Warsaw</s2><s3>POL</s3><sZ>1 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Pologne</country><wicri:noRegion>Warsaw</wicri:noRegion></affiliation></author><author><name sortKey="Flather, Marcus D" sort="Flather, Marcus D" uniqKey="Flather M" first="Marcus D." last="Flather">Marcus D. Flather</name><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Royal Brompton Hospital</s1><s2>London</s2><s3>GBR</s3><sZ>10 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Van De Werf, Frans" sort="Van De Werf, Frans" uniqKey="Van De Werf F" first="Frans" last="Van De Werf">Frans Van De Werf</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Universitair Ziekenhuis Gasthuisberg</s1><s2>Leuven</s2><s3>BEL</s3><sZ>11 aut.</sZ></inist:fA14><country>Belgique</country><wicri:noRegion>Universitair Ziekenhuis Gasthuisberg</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">The American heart journal</title><title level="j" type="abbreviated">Am. heart j.</title><idno type="ISSN">0002-8703</idno><imprint><date when="2003">2003</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">The American heart journal</title><title level="j" type="abbreviated">Am. heart j.</title><idno type="ISSN">0002-8703</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute</term><term>Antiplatelet agent</term><term>Chemotherapy</term><term>Coronary artery</term><term>Coronary heart disease</term><term>Fibrinolytic</term><term>Human</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Cardiopathie coronaire</term><term>Traitement</term><term>Fibrinolytique</term><term>Chimiothérapie</term><term>Inhibiteur thromboagrégation</term><term>Homme</term><term>Aigu</term><term>Artère coronaire</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background Many agents are available to treat acute coronary syndromes (ACS), yet limited information is available about their use from a multinational perspective. The objective of this report was to describe patterns of use of antithrombotic and antiplatelet therapies in patients with the spectrum of ACS through the use of data from the Global Registry of Acute Coronary Events (GRACE). Methods Data from 12,665 patients with ACS were analyzed. Baseline characteristics, clinical presentation, and medication use were compared. Regional differences in the administration of antiplatelet and antithrombotic therapies were analyzed. Multivariable logistic regression was implemented to determine independent variables indicating the use of various hospital therapies. Results Overall, unfractionated heparin was used in 57% of patients and low-molecular-weight heparin in 47% (P < .0001). More than 90% of patients received aspirin, but approximately 13% were not discharged on aspirin. Overall, 30% of patients received thienopyridines (with percutaneous coronary intervention [PCI] in 79%). Of those who did not receive aspirin, 31% received thienopyridines. Intravenous glycoprotein inhibitors were given to 17% of patients. Among those treated with PCI, only 47% received glycoprotein inhibitors, and 21% of those given glycoprotein inhibitors did not undergo PCI. Significant geographic variation was apparent in the use of unfractionated heparin, low-molecular-weight heparin, thienopyridines, and glycoprotein inhibitors. Conclusions Despite the availability of guidelines, striking geographic and practice variations are apparent in the use of antithrombotic and antiplatelet therapies. There remains significant room for improvement in the use of these therapies in patients with ACS, which should lead to improvement in care and outcomes.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Belgique</li><li>Brésil</li><li>Canada</li><li>France</li><li>Pologne</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Nouvelle-Galles du Sud</li><li>Ontario</li><li>Écosse</li><li>État de São Paulo</li><li>Île-de-France</li></region><settlement><li>Londres</li><li>Paris</li><li>Sydney</li><li>São Paulo</li><li>Toronto</li><li>Édimbourg</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Pologne"><noRegion><name sortKey="Budaj, Andrzej" sort="Budaj, Andrzej" uniqKey="Budaj A" first="Andrzej" last="Budaj">Andrzej Budaj</name></noRegion><name sortKey="Mazurek, Tomasz" sort="Mazurek, Tomasz" uniqKey="Mazurek T" first="Tomasz" last="Mazurek">Tomasz Mazurek</name></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Brieger, David" sort="Brieger, David" uniqKey="Brieger D" first="David" last="Brieger">David Brieger</name></region></country><country name="France"><region name="Île-de-France"><name sortKey="Steg, Gabriel" sort="Steg, Gabriel" uniqKey="Steg G" first="Gabriel" last="Steg">Gabriel Steg</name></region></country><country name="Canada"><region name="Ontario"><name sortKey="Goudman, Shaun G" sort="Goudman, Shaun G" uniqKey="Goudman S" first="Shaun G." last="Goudman">Shaun G. Goudman</name></region></country><country name="États-Unis"><noRegion><name sortKey="Dabbous, Omar H" sort="Dabbous, Omar H" uniqKey="Dabbous O" first="Omar H." last="Dabbous">Omar H. Dabbous</name></noRegion><name sortKey="Cannon, Christopher P" sort="Cannon, Christopher P" uniqKey="Cannon C" first="Christopher P." last="Cannon">Christopher P. Cannon</name></country><country name="Royaume-Uni"><region name="Écosse"><name sortKey="Fox, Keith A A" sort="Fox, Keith A A" uniqKey="Fox K" first="Keith A. A." last="Fox">Keith A. A. Fox</name></region><name sortKey="Flather, Marcus D" sort="Flather, Marcus D" uniqKey="Flather M" first="Marcus D." last="Flather">Marcus D. Flather</name></country><country name="Brésil"><region name="État de São Paulo"><name sortKey="Avezum, Alvaro" sort="Avezum, Alvaro" uniqKey="Avezum A" first="Alvaro" last="Avezum">Alvaro Avezum</name></region></country><country name="Belgique"><noRegion><name sortKey="Van De Werf, Frans" sort="Van De Werf, Frans" uniqKey="Van De Werf F" first="Frans" last="Van De Werf">Frans Van De Werf</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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