Short term outcomes of administering antiplatelet clopidogrel Loading dose in the Emergency Department for low-risk acute coronary syndrome patient in North West Bank hospitals رسالة ماجستير

Abstract

Background: Antiplatelet clopidogrel loading dose significantly improves outcome in patients undergoing Percutaneous coronary intervention; however, the efficacy of loading strategy before Percutaneous coronary intervention after coronary angiography versus routine pretreatment has not been fully characterized for low-risk Acute coronary syndrome patients. Aim: Identify the prevalence of clopidogrel loading dose short-term outcomes (Hematoma, Length of stay & Transient Ischemic Attack) in low-risk Acute coronary syndrome patients, the clinical manifestations of low-risk Acute coronary syndrome, and the relationship between group A and group B regarding patients’ characteristics (ages, gender, etc.), finally, to identify the prevalence of coronary angiography finding. Methodology: A prospective, descriptive, comparative, quantitative study design. A total of 352 patients with low-risk Acute coronary syndrome were convenient to receive a 300mg clopidogrel and 300mg aspirin loading dose, before coronary angiography (Group B n: 252), or post coronary angiography in case Percutaneous coronary intervention (Group A n:100). The endpoint was hematoma and Transient Ischemic Attack in case of coronary intervention and surgical intervention, Length of stay in case of surgical intervention. Result: There was a statistically significant difference (X2= 9.83 & Sig. = 0.020) due to the rate of endpoint, (hematoma, Transient Ischemic Attack) between the two groups, and for VI Length of stay for coronary artery bypass graft (t= 9.39, p<0.001). Hematoma occurs in 4% in group A and 8.1% in group B. Transient Ischemic Attack complication occur in 0.7% in group B and no any case in group A (0.0%). The mean Length of stay in group A is 4.18 days while in group B 6.59 days. Conclusion: Pretreatment Antiplatelet loading dose before elective coronary angiography increases the risk of minor bleeding complication, Transient Ischemic Attack, and increase Length of stay in case of surgical intervention. It can be administered safely in the catheterization lab between coronary angiography and Percutaneous coronary intervention in patient with low-risk Acute coronary syndrome. We suppose that Pretreatment antiplatelet loading dose should be used before planned elective Percutaneous coronary intervention, but not before planned elective coronary angiography.