prasugrel-hydrochloride and Chest-Pain

We aimed to analyze the 2020 standard of care in certified German chest pain units (CPU) with a special focus on non-ST-segment elevation acute coronary syndrome (NSTE-ACS) through a voluntary survey obtained from all certified units, using a prespecified questionnaire.. The assessment included the collection of information on diagnostic protocols, risk assessment, management and treatment strategies in suspected NSTE-ACS, the timing of invasive therapy in non-ST-segment elevation myocardial infarction (NSTEMI), and the choice of antiplatelet therapy.. The response rate was 75%. Among all CPUs, 77% are currently using the European Society of Cardiology (ESC) 0/3‑h high-sensitive troponin protocol, and only 20% use the ESC 0/1‑h high-sensitive troponin protocol as a default strategy. Conventional ergometry is still the commonly performed stress test with a utilization rate of 47%. Among NSTEMI patients, coronary angiography is planned within 24 h in 96% of all CPUs, irrespective of the day of the week. Prasugrel is the P2Y12 inhibitor of choice in ST-segment elevation myocardial infarction (STEMI), but despite the impact of the ISAR-REACT 5 trial on selection of antiplatelet therapy, ticagrelor is still favored over prasugrel in NSTE-ACS. If triple therapy is used in NSTE-ACS with atrial fibrillation, it is maintained up to 4 weeks in 51% of these patients.. This survey provides evidence that Germany's certified CPUs ensure a high level of guideline adherence and quality of care. The survey also identified areas in need of improvement such as the high utilization rate of stress electrocardiogram (ECG).. HINTERGRUND: Ziel der Arbeit war eine Versorgungsanalyse für das Jahr 2020 im Hinblick auf das akute Koronarsyndrom ohne ST-Strecken-Hebung (NSTE-ACS), welche anhand eines standardisierten Fragebogens in allen zertifizierten Brustschmerzeinheiten (CPU) in Deutschland durchgeführt wurde.. In die Bewertung flossen Diagnoseprotokolle, Risikobewertung, Management- und Behandlungsstrategien bei Verdacht auf NSTE-ACS, Zeitpunkt der invasiven Therapie beim Nicht-ST-Strecken-Hebungs-Myokardinfarkt (NSTEMI) und die Wahl der Thrombozytenaggregationshemmung ein.. Die Rücklaufquote betrug 75 %. Von allen CPU verwenden derzeit 77 % das ESC 0/3-h-high-sensitive-Troponin-Protokoll, und nur 20 % haben das ESC 0/1-h-high-sensitive-Troponin-Protokoll als Standardstrategie. Die konventionelle Ergometrie ist mit einer Durchführungsrate von 47 % nach wie vor der am häufigsten durchgeführte Belastungstest. Bei NSTEMI-Patienten wird in 96 % aller CPU, unabhängig vom Wochentag, eine Koronarangiographie innerhalb von 24 h geplant. Prasugrel ist der P2Y12-Inhibitor der Wahl beim ST-Strecken-Hebungs-Myokardinfarkt. Trotz der Ergebnisse der ISAR-REACT-5-Studie wird Ticagrelor beim NSTE-ACS immer noch gegenüber Prasugrel bevorzugt. Wird eine Tripeltherapie beim NSTE-ACS mit Vorhofflimmern eingeleitet, wird diese in 51 % der CPU bis zu 4 Wochen empfohlen.. Die vorliegende repräsentative Umfrage unter den zertifizierten CPU liefert Belege für ein hohes Maß an Leitlinienkonformität und Versorgungsqualität in diesen Einheiten. Die Analyse deckt jedoch auch Bereiche mit Verbesserungsbedarf (wie die unverändert hohe Rate an Belastungs-EKG) auf.

Topics: Acute Coronary Syndrome; Cardiology; Chest Pain; Germany; Humans; Non-ST Elevated Myocardial Infarction; Platelet Aggregation Inhibitors; Practice Patterns, Physicians'; Prasugrel Hydrochloride; ST Elevation Myocardial Infarction; Surveys and Questionnaires; Troponin

ACC/AHA guidelines support the use of the P2Y. Multicenter, longitudinal analysis of patients and hospitals in the National Cardiovascular Data Registry (NCDR) Chest Pain - MI Registry from the third quarter of 2013 to the first quarter of 2017.. A total of 362,354 AMI patients treated at 801 hospitals were included in our analysis. Ticagrelor use increased over time, from 6.1% in 2013 to 33.7% in 2017, with corresponding reductions in the use of clopidogrel and prasugrel (p < 0.001 for all trends). In multivariable models, patients of white race, with private insurance, or STEMI were more likely to receive ticagrelor (p < 0.05 for all). Hospitals in the highest quartile of ticagrelor uptake had use rates ranging from 29% to 88%, and were more likely to have the lowest volume of MI patients. The correlation between prasugrel and ticagrelor adoption was weakly positive (correlation coefficient: 0.15, p = 0.004); hospitals with the lowest early adoption of prasugrel started with the lowest rate of ticagrelor use and had the slowest rate of increase in ticagrelor use.. There has been a rapid increase in use of ticagrelor since its approval by the FDA and both patient and hospital characteristics were associated with variation in its adoption and utilization. Further examination of the characteristics associated with the rapid adoption of new evidence may provide insights about improving health system performance.

Topics: Chest Pain; Hospitals; Humans; Myocardial Infarction; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; Purinergic P2Y Receptor Antagonists; Registries; Ticagrelor; Treatment Outcome

Romiplostim is a thrombopoietin receptor agonist that increases platelet counts and restores platelet function in patients with chronic immune thrombocytopenia (ITP). Increase in platelet count and platelet activation has been associated with increased thromboembolic risk. The present case report describes an interesting case of acute stent thrombosis in a patient with chronic immune thrombocytopenic purpura (ITP) being treated with romiplostim.

Topics: Acute Disease; Aspirin; Chest Pain; Clopidogrel; Eptifibatide; Female; Humans; Middle Aged; Peptides; Piperazines; Platelet Aggregation Inhibitors; Platelet Count; Prasugrel Hydrochloride; Purpura, Thrombocytopenic, Idiopathic; Receptors, Thrombopoietin; Risk Factors; Stents; Thiophenes; Thrombosis; Ticlopidine; Ultrasonography, Interventional