Upload
taem
View
417
Download
2
Embed Size (px)
DESCRIPTION
Evening symposium: Anti-platelet therapy in ACS: Decisions today can impact a life - ผศ.พญ.ยุวเรศมคฐ์ สิทธิชาญบัญชา, พ.อ.พิเศษ นพ.นครินทร์ คันสนยุทธ
Citation preview
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?
คิดถึง ER…คิดถึง รามาธิบดี...