News | September 06, 2011

New European Antiplatelet Drug, Diagnostic Test Guidelines Updated

September 6, 2011 — The European Society of Cardiology (ESC) released the latest version of its guidelines for managing patients presenting without persistent ST-segment elevation. This version replaces earlier editions of 2000, 2002 and 2007. The new guidelines also incorporate the findings of very recent studies.

Among the notable new inclusions are recommendations on the use of the new antiplatelet drugs ticagrelor and prasugrel, which only became available in the past two years.

Ticagrelor is recommended for all patients at moderate-to-high risk of ischemic events (including those pre-treated with clopidogrel) and patients with unknown coronary anatomy. Prasugrel is recommended for those who are "clopidogrel naive" in whom coronary anatomy is known and who are proceeding to percutaneous coronary intervention (PCI); prasugrel should be avoided if there is a high risk of life-threatening bleeding or other contraindications. Clopidogrel is reserved for those patients who cannot take either medication.

The guidelines cite the PLATelet inhibition and patient Outcomes (PLATO) and TRITON-TIMI 38 trials as evidence of the superiority of the new drugs over clopidogrel.

There are also notable introductions in the sections on diagnosis. Risk stratification now takes into account the introduction of high-sensitivity troponin assays. These have largely replaced conventional troponin assays because of their higher diagnostic sensitivity. Accordingly, the new guidelines recommend the implementation of a rapid rule-out protocol when these high-sensitivity assays are available. It seems likely the guidelines will change practice in this diagnostic work-up when applying this fast-track protocol.

However, whatever the new introductions, the range of non-ST segment elevation acute coronary syndromes remains as wide and as frequent as ever. The guidelines put annual incidence at three per thousand population, with patients described as a heterogenous group with a variable prognosis. Risk stratification thus remains essential to their management.

The 2011 guidelines recommend use of the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) risk score to estimate the risk of in-hospital bleeding. The score should be used for patients with suspected non-ST-elevation acute coronary syndromes, as bleeding is still acknowledged as a major factor.

“It’s probably the best validated score because it’s based on more than 70,000 patients of the CRUSADE registry and was validated in a cohort of [more than] 17,000 patients,” says task force chairman Prof. Christian Hamm. “So it’s really very solid data.”

Previous guidelines have recommended the GRACE risk score to predict ischemic events. However, says Hamm, the new recommendation to also use the CRUSADE score will enable doctors to tailor treatment according to both risk scores. This, he adds, along with the introduction of high-sensitive troponin assays for diagnosis, are two "practice-changing" recommendations of the new guidelines.

For more information: www.escardio.org

Related Content

Icosapent Ethyl (Vascepa) significantly Reduces Revascularizations in Statin Patients in the REDUCE-IT REVASC analyses presented as a late-breaking study at SCAI 2020. Photo by Dave Fornell

Icosapent Ethyl (Vascepa) significantly reduces revascularizations in statin patients based on data from the REDUCE-IT REVASC analyses, presented as a late-breaking study at SCAI 2020. Photo by Dave Fornell

News | Pharmaceuticals | May 17, 2020
May 17, 2020 – Patients with high lipid levels have an increased risk for ischemic events, despite statin therapy.
Scott Wright, M.D., Mayo Clinic, presenting the results at ACC on the two-dose a year LDL-lowering drug inclisiran, which had a significant reduction in LDL in the ORION Trial. #ACC20 #ACC2020

Scott Wright, M.D., Mayo Clinic, presenting the results at ACC on the two-dose a year LDL-lowering drug inclisiran, which had a significant reduction in LDL in the ORION Trial.

News | Pharmaceuticals | March 28, 2020 | Dave Fornell, Editor
March 28.
The U.S. Food and Drug Administration (FDA) approved Esperion's bempedoic acid (Nexletor) tablet, an oral, once-daily, non-statin low-density lipoprotein cholesterol (LDL-C) lowering medicine. The drug is indicated as an adjunct to diet and maximally tolerated statin therapy for the treatment of adults with heterozygous familial hypercholesterolemia (HeFH) or established atherosclerotic cardiovascular disease (ASCVD) who require additional lowering of LDL-C. 
Feature | Pharmaceuticals | February 24, 2020
February 24, 2020 — The U.S.
This image shows the cardiac muscle fibers of a fruit fly under magnification. Iowa State University researchers have found a way to restore the strength and regularity of cardiac muscles in aging fruit flies. Photo by Hua Bai, Iowa State University.

This image shows the cardiac muscle fibers of a fruit fly under magnification. Iowa State University researchers have found a way to restore the strength and regularity of cardiac muscles in aging fruit flies. Photo by Hua Bai, Iowa State University.

News | Pharmaceuticals | January 09, 2020
January 9, 2020 – Researchers may have discovered a way to turn back the clock on aging heart muscles in fruit flies,
 Christie Ballantyne

Dr. Christie Ballantyne, professor of medicine and chief of the section of cardiology at Baylor College of Medicine

News | Pharmaceuticals | December 30, 2019
December 30, 2019 — A drug therapy targeting the production of a protein produced by the liver has led to sustained a
Vascepa pill contains a concentrated form of fish oil, icosapent ethyl, indication for prevention. The U.S. Food and Drug Administration (FDA) Dec. 13, 2019, approved the use of Vascepa (icosapent ethyl) capsules as an adjunctive therapy to reduce the risk of cardiovascular events in adults with elevated triglyceride levels.
Feature | Pharmaceuticals | December 16, 2019 | Dave Fornell, Editor
The U.S. Food and Drug Administration (FDA) approved the use of Vascepa (icosapent ethyl) capsules as an adjunctive...
Coronary CT angiography images of a coronary artery depicting the perivascular fat attenuation index (FAI) before and after biologic therapy at one-year follow-up. Patients had excellent response to biologic therapy, showing clear reductions in the inflammation in plaques that cause heart attacks and stokes. Image from the Oxford Academic Cardiovascular CT Core Lab and Lab of Inflammation and Cardiometabolic Diseases at NHLBI.

Coronary CT angiography images of a coronary artery depicting the perivascular fat attenuation index (FAI) before and after psoriasis biologic drug therapy at one-year follow-up. Patients had excellent response to biologic therapy, showing clear reductions in the inflammation in plaques that cause heart attacks and stokes. Image from the Oxford Academic Cardiovascular CT Core Lab and Lab of Inflammation and Cardiometabolic Diseases at NHLBI.

 

Feature | Pharmaceuticals | July 31, 2019
July 31, 2019 — Researchers found anti-inflammatory drug therapies used to treat moderate to severe psoriasis can sig
Quantum Genomics Enrolls First Patient in QUORUM Phase IIb Study of Firibastat
News | Pharmaceuticals | June 14, 2019
Quantum Genomics announced the enrollment of the first patient in its QUORUM Phase IIb study of its lead clinical...
FDA Grants Priority Review for Vascepa sNDA
News | Pharmaceuticals | May 29, 2019
Amarin Corp. plc announced that its supplemental new drug application (sNDA) for Vascepa (icosapent ethyl) capsules has...