Ticagrelor: Experience in STEMI & NSTEMI & UA ACS cases in ED Ramathibodi hospital

Yuwares Sittichanbuncha.Assist.Prof.

Emergency Department

Ramathibodi Hospital Medical School

Mahidol University

ห้องฉกุเฉิน โรงพยาบาลรามาธิบดี

หอ้งกูช้พี1, 2

หอ้งตรวจ จุดคัดกรอง

หอ้งท ำกำร

รักษำ

หอ้งสังเกต

อำกำร

หอ้งX-ray

Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. ESC Guidelines for the management of acute coronary

syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary

syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).

European heart journal. 2011;32(23):2999-3054.

ผู้ป่วยหญิงอาย ุ66 ปี underlying DM,HT มาห้องฉกุเฉินด้วยอาการจกุลิน้ป่ี 30 นาทีก่อนมาโรงพยาบาล

CPG Acute MI

•Multidisciplinary collaboration: ER, Cardio-medicine, Pathology

•Lean Operation: One stop service

•CQI •Evidence based medicine

CPG Acute MI

Chest pain prevalence in Rama ED 2011 2012 2013(6mos)

CC: Chest pain 858 906 376

Acute MI 115 (12%) 111 (12.25%)

59 (15.7%)

• Conclusion from PLATO trial

• Primary endpoint: Death from vascular causes(MI,CVA) ,Mortality ,MI ,Stent thrombosis decrease in Tecagrelor group

• CVA, Major Bleeding no dfference between Tecagrelor and Clopidogrel

2013 ACCF/AHA Guideline for the

Management of ST-Elevation Myocardial

Infarction: Executive Summary

by Patrick T. O’Gara, Frederick G. Kushner, Deborah D. Ascheim, Donald E. Casey, Mina K. Chung,

James A. de Lemos, Steven M. Ettinger, James C. Fang, Francis M. Fesmire, Barry A. Franklin,

Christopher B. Granger, Harlan M. Krumholz, Jane A. Linderbaum, David A. Morrow, L. Kristin

Newby, Joseph P. Ornato, Narith Ou, Martha J. Radford, Jacqueline E. Tamis-Holland, Jacqueline E.

Tommaso, Cynthia M. Tracy, Y. Joseph Woo, and David X. Zhao

Circulation

Volume 127(4):529-555

January 29, 2013

Copyright © American Heart Association, Inc. All rights reserved.

Inhibition of platelet reactivity

Gurbel PA, et al. Circulation. 2009;120:2577-2585.

[Gurbel 2009:B]

IPA, inhibition of platelet activity

Inhibition of platelet reactivity

Gurbel PA, et al. Circulation. 2009;120:2577-2585.

[Gurbel 2009:B]

IPA, inhibition of platelet activity

Steg PG, James S,

Harrington RA, et al.

Ticagrelor versus

clopidogrel in patients with

ST-elevation acute

coronary syndromes

intended for reperfusion

with primary percutaneous

coronary intervention: a

Platelet Inhibition and

Patient Outcomes (PLATO)

trial subgroup analysis. Circulation.2010;122:2131– 41.

ค าถาม ส าหรับ กรูู •ข้อแนะน าส าหรับแพทย์ หากพบกรณีเช่นนีท่ี้ รพช. ก่อน refer ? •Antiplatelet of choice? •Take home message?

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