Antistollingstherapie ACS Gillian Jessurun Scheper Ziekenhuis Emmen Invasieve

Invasieve Hartzorg Drenthe Achtergrond RIVM 6 -12 -2011

Invasieve Hartzorg Drenthe Zorgconcept- development Focus op service excellence met als kritische succesfactoren •

Invasieve Hartzorg Drenthe Adherentie • Regionale samenwerking (± 40% van totaal) – Assen –

Invasieve Hartzorg Drenthe Adherentie . 6 -12 -2011

Invasieve Hartzorg Drenthe Adherentie voor myocardinfarct 6 -12 -2011

Invasieve Hartzorg Drenthe Introduction • Acute coronary syndrome (ACS) is a continuum of disease

Invasieve Hartzorg Drenthe Antiplatelet therapy

Invasieve Hartzorg Drenthe Bleeding risk

Invasieve Hartzorg Drenthe Prasugrel vs. Ticagrelor Funnel plots comparing prasugrel vs. ticagrelor for the

Invasieve Hartzorg Drenthe And now daily practice • • • Which one to choose?

Invasieve Hartzorg Drenthe Different schemes • Based on the current evidence, we highlight an

Invasieve Hartzorg Drenthe Ann Pharmacother. 2011 Sep; 45(9): 1151 -6.

Invasieve Hartzorg Drenthe Our proposal • Develop a regional protocol in collaboration with –

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Antistollingstherapie ACS Gillian Jessurun Scheper Ziekenhuis, Emmen

Invasieve Hartzorg Drenthe Achtergrond RIVM 6 -12 -2011

Invasieve Hartzorg Drenthe Zorgconcept- development Focus op service excellence met als kritische succesfactoren • Adherentie • Indicatiestelling • Expertise • Behandelingsstrategie 6 -12 -2011

Invasieve Hartzorg Drenthe Adherentie • Regionale samenwerking (± 40% van totaal) – Assen – Hoogeveen – Stadskanaal – Hardenberg – Elders (Martini Ziekenhuis, Emlichheim etc. ) • Service zonder wachttijden (korte opname duur) • Hoge prevalentie in dunbevolkt gebied 6 -12 -2011

Invasieve Hartzorg Drenthe Adherentie . 6 -12 -2011

Invasieve Hartzorg Drenthe Adherentie voor myocardinfarct 6 -12 -2011

Invasieve Hartzorg Drenthe Introduction • Acute coronary syndrome (ACS) is a continuum of disease that includes non-STsegment elevation ACS and ST-segment elevation myocardial infarction. • Defining the developing role of antiplatelet therapy in ACS and compare the available P 2 Y₁₂ receptor inhibitors.

Invasieve Hartzorg Drenthe

Invasieve Hartzorg Drenthe Antiplatelet therapy

Invasieve Hartzorg Drenthe

Invasieve Hartzorg Drenthe Bleeding risk

Invasieve Hartzorg Drenthe

Invasieve Hartzorg Drenthe STEMI

Invasieve Hartzorg Drenthe Prasugrel vs. Ticagrelor Funnel plots comparing prasugrel vs. ticagrelor for the risk of key clinical events. Int J Cardiol. 2011 Sep 1; 151(2): 228 -9.

Invasieve Hartzorg Drenthe

Invasieve Hartzorg Drenthe And now daily practice • • • Which one to choose? Which dose? Which combination? Timing of treatment Differences between STEMI, non-STEMI, unstable angina?

Invasieve Hartzorg Drenthe Different schemes • Based on the current evidence, we highlight an algorithm to aid clinicians in the selection of a P 2 Y₁₂ receptor inhibitor for patients with ACS in various clinical situations. Ann Pharmacother. 2011 Sep; 45(9): 1151 -6.

Invasieve Hartzorg Drenthe Ann Pharmacother. 2011 Sep; 45(9): 1151 -6.

Invasieve Hartzorg Drenthe Our proposal • Develop a regional protocol in collaboration with – Ambulances – General Practitioners – Adherent cardiologists and – Adherent Cardio-Thoracic surgeons – ROAZ • Based on the new guide lines: Prasu or Tica