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CRUSADE: NSTE ACS dosing of antithrombotics — study overview

CRUSADE: NSTE ACS dosing of antithrombotics — study overview. Objective: Investigate associations between dosing of unfractionated heparin (UFH), low-molecular- weight heparin (LMWH), and glycoprotein (GP) IIb/IIIa inhibitors and major clinical outcomes

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CRUSADE: NSTE ACS dosing of antithrombotics — study overview

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  1. CRUSADE: NSTE ACS dosing of antithrombotics—study overview Objective: Investigate associations between dosing of unfractionated heparin (UFH), low-molecular- weight heparin (LMWH), and glycoprotein (GP) IIb/IIIa inhibitors and major clinical outcomes Design: Prospective observational analysis Population: Registry patients with NSTE ACS receiving antithrombotic agents Primaryoutcome: Relation between excessive dosing of UFH, LMWH, and GP IIb/IIIa inhibitors and major bleeding, in-hospital mortality, and length of stay NSTE ACS = non–ST segment elevation acute coronary syndromes Alexander KP et al. JAMA. 2005;294:3108-16.

  2. Female Low bodyweight Diabetes CHF Major predictors of overdosing Older age(≥65 years) Renalinsufficiency Patients vulnerable to overdosing Alexander KP et al. JAMA. 2005;294:3108-16.

  3. Results: Excess dosing by age 70 P < 0.001 for all treatment groups 60 50 Excessdose(%) 40 30 20 10 0 UFH LMWH GP IIb/IIIa inhibitors Patient age (years) 65–74 <65 ≥75 Alexander KP et al. JAMA. 2005;294:3108-16.

  4. Results: Antithrombotic therapy dose and major bleeding 35 Underdosed Recommended Mild excess Major excess 30 25 P < 0.001 P = 0.25 P < 0.001 Majorbleeding(%) 20 15 10 5 0 n = 714 n = 922 n = 178 n = 237 n = 2063 n = 2327 n = 5879 n = 2074 n = 2073 n = 3998 n = 1955 UFH LMWH GP IIb/IIIa inhibitors Data are for non–coronary bypass grafting and nontransfer population Alexander KP et al. JAMA. 2005;294:3108-16.

  5. Recommended dosing of antithrombotic agents Alexander KP et al. JAMA. 2005;294:3108-16.

  6. Clinical implications • Early use of antithrombotic agents plays a key role in management of NSTE ACS, but dosing errors are common • Dosing errors occur more often in elderly and others already vulnerable to bleeding • Dosing errors predict an increased risk of major bleeding • Altering dosing based on weight and renal function minimizes bleeding while preserving therapeutic benefit • Patients receiving recommended doses of heparin and GP IIb/IIIa inhibitors alone or in combination have the lowest rates of bleeding Proper dosing of antithrombotic therapies is necessary to prevent bleeding complications in vulnerable patients Alexander KP et al. JAMA. 2005:294:3108-16.

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