Actual Issues of Ischemic and Hemorrhagic Events Risk Management During Antithrombotic Therapy in Patients with Acute Coronary Syndrome
Open Access
- 30 December 2020
- journal article
- research article
- Published by Silicea - Poligraf in Rational Pharmacotherapy in Cardiology
- Vol. 16 (6), 1024-1030
- https://doi.org/10.20996/1819-6446-2020-12-10
Abstract
Today, optimal duration of double antiplatelet (DAPT) and triple antithrombotic therapy (TATT) in patients with acute coronary syndrome (ACS) remains the subject of scientific and practical discussion on possibilities of ischemic and hemorrhagic risks assessment. Good clinical risk metrics is based on validated risk scales. However, actual clinical guidelines do not provide a universal and generally accepted scale for assessing the balance of risks of ischemic events and bleeding. Is very necessary to determine the optimal content and DAPT or TATT duration is the existence of validated risk assessment scales would allow to optimize the accuracy of risk assessment of ischemic and hemorrhagic events in patients after ACS. One of the probable reasons is absence of validation of existing scales for each specific population of patients with ACS. In this regard, the use of «new» risk assessment systems: PRECISE DAPT and DAPT, in addition to the routine risk assessment scales (GRACE, CRUSADE), could become optimal in all ACS patient categories. In order to identify the initial risk of community-acquired hemorrhagic events during the first 12 months all patients with ACS at the inpatient stage of treatment is used the PRECISE DAPT score. In order to determine the need for prolongation of the standard DAPT. It should be used after 12 months of receiving DAPT in survivors of ACS patients without ischemic events, must be used the DAPT score.Keywords
This publication has 23 references indexed in Scilit:
- Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trialThe Lancet, 2013
- Comparison of the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION bleeding risk scores in STEMI undergoing primary PCI: insights from a cohort of 1391 patientsEuropean Heart Journal Acute Cardiovascular Care, 2012
- Ticagrelor versus clopidogrel in patients with acute coronary syndromes intended for non-invasive management: substudy from prospective randomised PLATelet inhibition and patient Outcomes (PLATO) trialBMJ, 2011
- Cangrelor — A Champion Lost in Translation?The New England Journal of Medicine, 2009
- Clopidogrel added to aspirin versus aspirin alone in secondary prevention and high-risk primary prevention: Rationale and design of the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trialAmerican Heart Journal, 2004
- Aspirin Protects Endothelial Cells From Oxidant Damage Via the Nitric Oxide-cGMP PathwayArteriosclerosis, Thrombosis, and Vascular Biology, 2003
- Safety profile and tolerability of intravenous AR-C69931MX, a new antiplatelet drug, in unstable angina pectoris and non—Q-wave myocardial infarctionClinical Therapeutics, 2002
- Simple Scoring Scheme for Calculating the Risk of Acute Coronary Events Based on the 10-Year Follow-Up of the Prospective Cardiovascular Münster (PROCAM) StudyJournal of the American College of Cardiology, 2002
- The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial programme. Rationale, design and baseline characteristics including a meta-analysis of the effects of thienopyridines in vascular diseaseEuropean Heart Journal, 2000
- Clinical pharmacology of platelet cyclooxygenase inhibition.Journal of the American College of Cardiology, 1985