Dual antiplatelet therapy in percutaneous coronary intervention managed acute coronary syndrome patients

Abstract

Background: Cardiovascular disease (CVD) is one of the leading causes of death and a major health issue in Malta. Of the CVD, acute coronary syndromes (ACS) are now managed with percutaneous coronary intervention (PCI). Following stent insertion patients are treated with dual antiplatelet therapy to prevent cardiovascular events. Study purpose: The aim of this study was to address the following PICO question; "Is there a significant decrease in cardiovascular events when comparing prasugrel and aspirin to clopidogrel and aspirin in patients managed with percutaneous coronary intervention following acute coronary syndrome?" Method: CINAHL and PubMed were the databases used for searching the literature. Inclusion and exclusion criteria included, RCTs published in English, comparing prasugrel and aspirin to clopidogrel and aspirin, PCI managed ACS patients, the outcome a significant decrease in cardiovascular events. The PRISMA guidelines were applied to ensure a systematic approach in the search strategy. 9 research studies were identified. The critical appraisal tool (NHS UK) RCTs checklist was used to appraise the literature. Finding: The results of the main studies showed that prasugrel was superior to clopidogrel in reducing cardiovascular events with a risk of bleeding in elderly, low body weight and patients with a history of stroke or TIA. STEMI and persons with diabetes, and switching clopidogrel to prasugrel showed good end results. Conclusion: Prasugrel is recommended in PCI managed ACS patients particularly persons with ST segment elevation myocardial infarction, diabetics, and non-responders to clopidogrel. Nurses play an important role in patient education. Bilateral meetings in collaboration with cardiologists, nurses, pharmacists and health authorities is planned to introduce prasugrel onto the Schedule V list on the basis of the results in the study.