Physicians' Academy for Cardiovascular Education

Early Initiation of antiplatelet therapy: Pre-treatment in ACS, facts and fictions

Sep. 10, 2013


Keep checking this site, as more presentations and webcasts related to the PACE Educational Programmes will be available in the near future.
 
As part of the ESC congress 2013, the PACE Foundation organised three EBAC Accredited Educational Programmes:

PCSK9: the new lipid target in preventive cardiology?

Inflammation & cardiovascular disease: Exploring new options for intervention

Early Initiation of antiplatelet therapy:Pre-treatment in ACS, facts and fictions


Via these EBAC-accredited educational programs, the PACE Foundation aims to help physicians to assimilate the proven findings of scientific research into the day-to-day practice of clinical medicine, aiming to improve outcomes in patients.
 
The symposium was co-chaired by Prof.dr. Wouter Jukema and Prof.dr. Peter Clemmensen. The presentations in this session were interlaced with questions about the presented data in relation to the audience’s customs in clinical practice, to stimulate an active participation of the audience.
 
Antiplatelet agents form the cornerstone in the management of patients with acute coronary syndrome (ACS). Patients undergoing PCI receive antiplatelet therapy to reduce the risk of ischaemic events, whereby the risk of bleeding should be limited.
Prof. dr. Gilles Montalescot (Paris, France) gave a comprehensive overview of the available evidence of the effect of pre-treatment with P2Y12 inhibitors before catheterisation of patients presenting with NSTE-ACS. Although current guidelines suggest that pre-treatment is good for patients, no trial has ever randomised NSTE-ACS patients who are managed invasively to pre-treatment or to no pre-treatment. Data of the ACCOAST study were presented at the ESC congress and show that pre-treatment with prasugrel does not reduce major ischemic events through 30 days, but it does increase major bleeding complications. The same result was seen across multiple patient subgroups. Thus, reappraisal of routine pre-treatment strategies in NSTE-ACS is needed.
 
Prof.dr. Petr Widimsky (Prague, Czech Republic) invited the audience to think along about the management of two case reports from his clinical practice. An interactive discussion was achieved through asking for votes of the audience on preferred treatment strategies.
 
Prof.dr. Peter Clemmensen (Copenhagen, Denmark) discussed the benefit of pre-hospital pre-treatment with prasugrel in STEMI patients, in regions with established protocols for the use of prehospital thienopyridine loading. He discussed data from the MULTIPRAC study that provided real-world data on the implementation and outcomes of prasugrel preloading in STEMI patients. The data suggest that pre-hospital initiation of thienopyridines in STEMI is safe with a low rate of MACE, in-hospital mortality and non-CABG bleeding requiring transfusions, which confirms the appropriateness of current guidelines to start STEMI treatment as soon as possible, extending into pre-hospital setting.
 
- Gilles Montalescot : The association of pretreatment with clinical outcomes in patients undergoing PCI
- Petr Widimský:  Everyday clinical practice experience: Case reports
- Peter Clemmensen:  Learnings on early initiation of antiplatelet therapy from registries

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