Pre-admission antiplatelet therapy in patients presenting with acute coronary syndrome

Abstract

INTRODUCTION AND OBJECTIVES: Some patients who present with acute coronary syndrome (ACS) are on prophylactic antiplatelet therapy prior to hospital admission. This study aims to describe factors associated with pre-admission antiplatelet use in patients with ACS admitted to a tertiary care setting. METHODS: With informed consent, data was gathered from patients diagnosed with ACS at the Colombo North Teaching Hospital over 18 months, using a validated questionnaire. Demographic data, risk factors, management and early outcome were analysed using SPSS 17. RESULTS: 254 (33.2%) of a total of 765 patients were on antiplatelet therapy prior to hospital admission. 62/254 (24.5%) were on primary prophylaxis, while 192/254 (75.5%) were on secondary prophylaxis for coronary artery disease (CAD). Although 265 patients had a history of CAD, only 192 (72.4%) were on secondary prophylaxis. Most (115/192 - 59.9%) were on two antiplatelet agents at the time they developed ACS this time. The commonest risk factor for commencing primary prophylaxis was diabetes mellitus (47/62 - 75.8%), and most (52/62 - 83.9%) were on a single anti-platelet agent. Early outcome (death, recurrent ACS) was not significantly associated with pre-admission use of antiplatelet agents as primary or secondary prophylaxis. CONCLUSIONS: A quarter of the patients with pre-existent CAD were not on any antiplatelet agent. One-third of patients developed ACS while on antiplatelet therapy. This highlights the need for better strategies for prevention of ACS. Acknowledgements: Japan International Cooperation Agency.