Antiplatelet and anticoagulant therapy for non-ST-elevation acute coronary syndromes in a general hospital

Aim To audit compliance with the 2011 European Society of Cardiology (ESC) guidelines for prescribing antiplatelet and anticoagulant therapy in patients diagnosed with non-ST-elevation acute coronary syndromes (NSTE-ACS). Methods Five-month audit at Cardiac Catheterisation Suite, Mater Dei Hospital, Malta. A data collection form for inpatients diagnosed with NSTE-ACS was developed, psychometrically evaluated and completed for each patient by the investigator. Comparative analysis to assess whether these patients were being managed according to the guidelines was undertaken. Results 165 patients were recruited; 73% were male, 37% were between 66 and 75 years and 44% were active smokers. The most common risk factors for cardiovascular disease in these patients were hypertension (27%), dyslipidemia and obesity (both 16%). 41% of the patients underwent a percutaneous coronary intervention, either ad hoc (34%) or elective (7%). Compliance to guidelines for prescription of aspirin and clopidogrel 300mg loading dose was 95% and 88% respectively. Compliance to guidelines for prescription of aspirin and clopidogrel 75mg daily maintenance dose was 97% and 96% respectively. Compliance to guidelines for prescription of proton pump inhibitors (PPIs) in patients receiving dual antiplatelet therapy (DAPT) was only 19%; 81% of the patients were prescribed omeprazole against guideline recommendations. Compliance to guidelines for prescription of anticoagulation therapy was 95% with respect to prescription of heparin treatment in combination with DAPT. Compliance to guidelines for prescription of enoxaparin was 81%. Compliance to guidelines for other antiplatelet and anticoagulant drugs recommended in the guidelines, including ticagrelor, prasugrel, glycoprotein IIb/IIIa receptor antagonists, fondaparinux and bivalirudin, was not measured. Conclusions Prescription of antiplatelet and anticoagulant therapy for NSTE-ACS in Malta is predominantly in accordance with ESC guidelines. Alternative antiplatelet and anticoagulant drugs and PPIs should be included in the Maltese hospital formulary to improve NSTE-ACS management in line with guideline recommendations.