Medically Ill Lit. Update Series- Vol. 2: Emerging Antithrombotic Treatment Options for Acute Coronary Syndromes

Faculty

Needs Statement

Acute coronary syndrome (ACS) is a broad term that has evolved to represent a spectrum of diseases from unstable angina (UA) to myocardial infarction (MI) with or without ST-segment elevation (STEMI or NSTEMI, respectively). While these conditions have very different presentations and are associated with differing levels of risk, they appear to share a common pathophysiologic pathway that includes ruptured plaque and thrombosis. Given the high rates of morbidity and mortality associated with these conditions, they are an important clinical challenge for clinicians. According to data from the American Heart Association, a conservative estimate of the number of US hospital discharges (in 2003) for patients with ACS is 879 000, of which 57% were men. If secondary discharge diagnoses are included in the estimate, the overall number of ACS discharges increases to more than 1.5 million. The risk of death associated with ACS varies according to the particular condition, with the highest risk observed with STEMI and NSTEMI compared with UA. Data from the Global Registry of Acute Coronary Events (GRACE) indicate that among more than 15 000 patients hospitalized with ACS, 6-month postdischarge death rates were 4.8% in patients with STEMI, 6.2% in patients with NSTEMI, and 3.6% in patients with UA. In addition, roughly 20% of patients in each group were readmitted to hospital for heart disease during the 6 months following the initial ACS discharge. ACS is also associated with a significant financial burden. The AHA estimates that overall direct and indirect costs of coronary heart disease totaled more than $142 billion in the US in 2006. Treatment of ACS generally includes the administration of antithrombotic agents as well as several other classes of drugs, including nitrates, beta blockers, angiotensin-converting enzyme (ACE) inhibitors to reduce the risk of ischemia, and statins and other lipid-regulating agents. While recent advances in antithrombotic therapy have resulted in significant reductions in ischemic events in patients with ACS, these improvements have been accompanied by increases in the risk of bleeding complications. Therefore, clinicians have increasingly been faced with balancing the benefit of improved cardiac outcomes wth the increased mortality associated with increased bleeding. The focus of the following report is on new developments in antithrombotic therapies for ACS, with a particular emphasis on those agents used for anticoagulation.

Target Audience

Clinicians who deal with medically ill patients.

Objectives

1. Teach them how to identify patients who might be at increased risk for acute coronary
syndromes (ACS);
2. Teach them how to assess the broad and diverse range of clinical complications that
result from ACS;
3. Discuss therapeutic strategies for ACS correlated to the degree of risk in a given
patient;
4. Describe potential pharmacologic options for ACS management.

 

Accreditation

Medicine
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Kentucky College of Medicine and Continuing Edge, a division of Global Edge, Inc. The University of Kentucky College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Kentucky College of Medicine designates this educational activity for a maximum of 1.00 AMA PRA Category 1 Credits™. Each physician should claim only those hours of credit actually spent in the educational activity.

The University of Kentucky College of Medicine presents this activity for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of medicine. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.

Nursing
Educational Review Systems is an approved provider of continuing education in nursing by ASNA, an accredited provider by the ANCC/Commission on Accreditation and designates this educational activity for a maximum of 1.00 hour(s). Provider # 05-115-07-075

Educational Review Systems is also approved for nursing continuing education by the state of California and the District of Columbia.

Pharmacy
The University of Kentucky College of Pharmacy is approved by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity has been assigned ACPE # 022-999-07-154--H04-P and will award 1.00 contact hours (0.1 CEUs) of continuing pharmacy education credit in states that recognize ACPE providers. Statements of credit will indicate hours and CEUs based on successful completion of a posttest (score 70% or higher) and will be issued upon completion of the activity. The college complies with the Criteria for Quality for continuing education programming.

Faculty Disclosure

Dr. Faxon receives consultation fees from Bristol-Myers Squibb and
sanofi-aventis.

Dr. Bauer is on the speakers bureau for GlaxoSmithKline.

Activity Sponsorship

This activity is jointly sponsored by the University of Kentucky and Continuing Edge, a division of Global Edge, Inc. Supported by an unrestricted educational grant from GlaxoSmithKline.