Major Adverse Cardiovascular and Cerebrovascular Events (MACCE), Major Bleeding
Conditions
Keywords
Dual antiplatelet therapy, Pretreatment with DAPT, Acute coronary syndrome
Brief summary
This is a chart review of data on use of antiplatelet (AP) medications for acute coronary syndrome in the ER. Guidelines recommend giving aspirin in the ER and a second AP agent in the cath lab. What is the outcome when the 2 agents are given n the ER?
Detailed description
Dual antiplatelet therapy (DAPT) is a standard treatment in ST-elevation myocardial infarction (STEMI) and non-ST-segment-elevation acute coronary syndrome (NSTEACS) . However, the timing of initiation of DAPT in the Emergency Department (ED) has been defined by recent western guidelines (i.e., aspirin in the ER and and a second AP agent when the coronary anatomy has been denied in the cath lab. This strategy aims at decreasing the incidence of bleeding events. However, patients with ACS in the Middle East are younger than those in the West and have lower bleeding risk. The purpose of this study is to evaluate the incidence of major bleeding in patients who received DAPT in the ED according to the discretion of the treating physician.
Interventions
None listed
Sponsors
Jordan Collaborating Cardiology Group
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients * Presenting with acute coronary syndrome (ST segment elevation myocardial infarction, non ST segment elevation myocardial infarction, and unstable angina). * Antiplatelet medication (s) prescribed during index admission to hospital. * Willingness of the patient to be called for follow up up to 1 year after index hospitalization.
Exclusion criteria
* Non cardiac chest pain. * No administration of antiplatelet agents during hospitalization. * Refusal of contact for follow up.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Major bleeding event | From enrollment to the end of the study at 1 year. | Major bleeding event is defined as any of the following: 1. bleeding causing hemodynamic compromise, 2. bleeding necessitating blood transfusion, or 3. bleeding in a closed space (intracerebral intraspinal and intraocular). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Major adverse cardiovascular and cerebral events | from enrollment to 1 year | Occurrence of any of the followings: 1. Cardiovascular death (death due to documented cardiovascular event: fatal myocardial infarction, or fatal stroke), 2. Non fatal myocardial infarction (two of three criteria: ischemic chest pain, electrocardiographic changes \[ST segment deviation and T wave inversion\] and elevated cardiac enzymes), 2. Definite stent thrombosis (demonstrating a thrombus in the stent on coronary angiography), 3. Non fatal stroke (new neurological deficit compatible with cerebral ischemia, brain imaging by computed tomography or magnetic resonance showing typical stroke, ischemic or hemorrhagic), 4. Coronary revascularization by percutaneous intervention or coronary bypass surgery. |
Countries
Jordan
Contacts
Primary ContactAyman Hammoudeh, MD, FACC
Backup ContactLaith Habahbeh, MD
Outcome results
None listed