Understanding and Treating Acute Coronary Syndrome - FreeCE
Understanding and Treating Acute Coronary Syndrome - FreeCE
Understanding and Treating Acute Coronary Syndrome - FreeCE
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Page 11<strong>Underst<strong>and</strong>ing</strong> <strong>and</strong> <strong>Treating</strong> <strong>Acute</strong> <strong>Coronary</strong> <strong>Syndrome</strong>© 2010 Pharmaceutical Education Consultants, Inc. unless otherwise noted. All rights reserved.Reproduction in whole or in part without permission is prohibited.Results from Genetic Testing• Increase the clopidogrel dose ?• Switch to ticlopidine or prasugrel ?• Add cilostazol ?Other Options• Use H 2 blockers (but not cimetidine)• Use prasugrel• Do genetic testing• Assess platelet reactivity with VerifyNow Assay• We don't have definitive outcome data onany of these options in clopidogrelnonresponders yet.4131Recent/Ongoing Trials• GRAVITAS (www.theheart.org)• R<strong>and</strong>omizing to high-dose vs usual-doseclopidogrel in patients ―resistant to clopidogrel‖• No significant difference in outcomes• TRIGGER PCI• r<strong>and</strong>omizing to normal dose clopidogrel orprasugrel• “resistance to clopidogrel” using VerifyNow Assay plateletreactivity units (PRU) > 23543Future antiplatelet agent• Ticagrelor (Brilinta ® , Astra Zeneca)Ticagrelor versus Clopidogrelin Patients with <strong>Acute</strong><strong>Coronary</strong> <strong>Syndrome</strong>sWallentin et al.New Engl<strong>and</strong> Journal of Medicine2009;361:1045-105744
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