Atherothrombosis
Acute Coronary Syndrome (ACS)

The Risk of Acute Coronary Syndrome (ACS)

ACS Discharges —In the US, approximately 879,000 patients were discharged from the hospital with a primary diagnosis of ACS in 2003 4

  • Of these, 767,000 were for myocardial infarction (MI) and 112,000 were for unstable angina (UA). 4
  • 28% of 1,218 major cardiac events occurred in ACS (UA/NSTEMI) patients following hospital discharge. 18
  • 31% of ACS patients experience a recurrent ischemic event within one year. 18

Thrombosis is the usual underlying cause of ACS, a spectrum of conditions that include UA, non–ST–segment elevation myocardial infarction (NSTEMI), and ST segment elevation (STEMI). 21

Disruption of atherosclerotic plaque is a complex pathological process that can lead to acute coronary syndrome. When a vulnerable plaque ruptures, it leads to the adhesion, activation, and aggregation of platelets, and activation of the clotting cascade, which can result in the formation of an occlusive thrombus. 21

Potentially modifiable risk factors for thrombosis, which result in ischemic manifestations such as ACS, include:

  • Hyperlipidemia
  • Hypertension
  • Diabetes
  • Cigarette smoking

This year, approximately 1.2 million Americans will have a new or recurrent coronary attack. It is estimated that 700,000 new attacks and 500,000 recurrent attacks occur annually. Read more about myocardial infarction.

Relevant Studies — The REACH Registry & ACTION Registry®–GWTG™

  • The REduction of Atherothrombosis for Continued Health — or REACH — Registry conducted a study of more than 69,000 patients, to identify comparable patterns in atherosclerosis risk factor prevalence. Read about the REACH Registry study.

  • ACTION Registry–GWTG is a national, risk-adjusted, outcomes-based quality improvement program that helps participating facilities measure and improve care for high-risk ACS patients with STEMI and NSTEMI. The ACTION Registry–GWTG is a result of the collaboration between the two leading national coronary artery disease registries, the NCDR® ACTION Registry–GWTG and the American Heart Association (AHA) Get With The GuidelinesSM-CAD Registry.

    Combining the strengths of the two programs, ACTION Registry–GWTG will collect a comprehensive set of data elements that provide healthcare professionals and their facilities with the information they need to monitor and improve adherence to the most current, science-based ACC/AHA treatment guidelines. Read more about ACTION Registry–GWTG

Indications
–
Use PLAVIX plus aspirin for patients with non–ST–segment elevation acute coronary syndrome (UA/non–Q–wave MI), including patients to be managed medically and those to be managed with percutaneous coronary intervention (with or without stent) or CABG, to decrease the rate of a combined end point of CV death, MI, or stroke as well as the rate of a combined end point of CV death, MI, stroke, or refractory ischemia.

–
Use PLAVIX plus aspirin for patients with ST–segment elevation acute myocardial infarction to reduce the rate of death from any cause and the rate of a combined end point of death, reinfarction, or stroke. This benefit is not known to pertain to patients who receive primary angioplasty.

–
Use PLAVIX alone for patients with a history of recent stroke, recent MI, or established PAD to reduce the rate of a combined end point of new ischemic stroke (fatal or not), new MI (fatal or not), and other vascular death.
Important Risk Information 18
–
PLAVIX is contraindicated in patients with active pathologic bleeding such as peptic ulcer or intracranial hemorrhage. PLAVIX should be used with caution in patients who may be at risk of increased bleeding from trauma, surgery, or coadministration with NSAIDs or warfarin. (See CONTRAINDICATIONS and PRECAUTIONS.*)

–
The rates of major and minor bleeding were higher in patients treated with PLAVIX plus aspirin compared with placebo
plus aspirin in clinical trials. (See ADVERSE REACTIONS.*)

–
Due to an expected reduction in drug levels and clinical efficacy, concomitant use of drugs that inhibit CYP2C19 (eg, omeprazole) should be discouraged. (See PRECAUTIONS.*)

–
As part of the worldwide post–marketing experience with PLAVIX, there have been cases of reported thrombotic thrombocytopenic purpura (TTP), some with fatal outcome. TTP has been reported rarely following use of PLAVIX, sometimes after a short exposure (<2 weeks). TTP is a serious condition that can be fatal and requires urgent treatment including plasmapheresis (plasma exchange). (See WARNINGS.*)

–
Based on literature, patients with genetically reduced CYP2C19 function have diminished responses and generally exhibit higher CV event rates following MI. (See PRECAUTIONS.*)

–
In clinical trials, the most common clinically important side effects were pruritus, purpura, diarrhea, and rash; infrequent events included intracranial hemorrhage (0.4%) and severe neutropenia (0.05%). (See ADVERSE REACTIONS.*)