%0 Journal Article
%T Novel Antiplatelet Agent Use for Acute Coronary Syndrome in the Emergency Department: A Review
%A M. Curial
%A E. Nath
%A E. Lang
%J Cardiology Research and Practice
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/127270
%X Background. Acute Coronary Syndrome (ACS) is a clinical condition encompassing ST Segment Elevation Myocardial Infarction (STEMI), Non-ST Segment Elevation Myocardial Infarction (NSTEMI), and Unstable Angina (UA) and is characterized by ruptured coronary plaque, ischemic stress, and/or myocardial injury. Emergency department (ED) physicians are on the front lines of ACS management. The role of new antiplatelet agents ticagrelor and prasugrel in acute ED management of ACS has not yet been defined. Objective. To critically review clinical trials using ticagrelor and prasugrel in the treatment of ACS and inform practitioners of their potential utility in treating ACS in the ED. Results. Trials on the efficacy of ticagrelor and prasugrel achieve statistical significance in decreasing composite endpoints in select patient populations. Conclusion. The use of ticagrelor and prasugrel as first line ED treatment of ACS is not well established. Current evidence supports the use of several agents with the final decision based on treatment protocols conjointly developed between cardiology and emergency medicine (EM). Further clinical trials involving head-to-head trials or comparisons of drug-based strategies are required to show superiority in reducing cardiac endpoints with regard to ED initiation of treatment. 1. Introduction Acute Coronary Syndrome (ACS) is a clinical syndrome comprising ST Segment Elevation Myocardial Infarction (STEMI), Non-ST Segment Elevation Myocardial Infarction (NSTEMI), and Unstable Angina (UA). ACS is a common and important diagnosis that is often made in the emergency department by front-line physicians and rapid recognition and diagnosis of ACS, risk stratification, and appropriate treatment have been shown to decrease morbidity and mortality [1]. In the context of ACS treatment, dual antiplatelet therapy with ASA and clopidogrel (a P2Y12 receptor inhibitor) reduces rates of harmful cardiac events such as cardiovascular causes of death, myocardial infarction, and stroke [2]. However, with new agents undergoing evaluation in large clinical trials, acute care providers need to know if the new P2Y12 receptor inhibitor antiplatelet agents ticagrelor and prasugrel are clinically superior to the current standard clopidogrel. It has been established that a defined percentage of the population exhibits high platelet activity despite the use of clopidogrel. This phenomenon occurs anywhere from 5% to 44% of patients studied depending on the clopidogrel dose and patient population [3]. It is uncertain what level of platelet activity during ACS
%U http://www.hindawi.com/journals/crp/2013/127270/