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Journal de Pharmacie Clinique

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Antiglycoprotein IIb/IIIa use in patients presenting an acute coronary syndrome Volume 24, issue 3, juillet-août-septembre 2005

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Authors
Pharmacie Hôpital Arnaud de Villeneuve/Lapeyronie, CHU Montpellier, Service de cardiologie A, Hôpital Arnaud de Villeneuve, CHU Montpellier

Platelet glycoprotein IIb/IIIa inhibitor (GPI) are effective but very expensive antiplatelets agents. The aim of the study was to evaluate, in our institution, the context of use of GPI in patients with acute coronary syndromes (ACS), to emit local and consensual recommendations on the use of these medicines in close agreement with European guidelines and medicines label. Among the 210 patients were included in the study, only 29 patients benefited effectively from a treatment by GPI. Among them, 13 patients were treated for myocardial infarctus (MI) and 16 for refractory unstable angina. Among them, GPI was prescribed off-label for 16 patients. According to the European guidelines for ACS treatments, 40 patients with MI and 60 with refractory unstable angina should have been treated with GPI. A local consensus among doctors and pharmacists optimized the use of GPI in our hospital, by selecting the patients with the higher cardiovascular risk levels. Moreover, GPI treatments are now reserved to patients with serious MI and with a sending period of less than 90 minutes, or to patients with refractory unstable angina with at least 2 criteriae of bad prognostic or a high troponin level associated to a particular context (a disrupted electrocardiogram, an alarming clinical state, etc.). This stratification of the patients allowed to respect budgets foreseen for this drugs category while taking care of ACS in an optimal way.