Antiplatelet Therapy in Patients with Unstable Angina and Non-ST-Segment-Elevation Myocardial Infarction: Findings from the CRUSADE National Quality Improvement Initiative

Michael B. Bottorff, Pharm.D.; Edith A. Nutescu, Pharm.D.; Sarah Spinler, Pharm.D.


Pharmacotherapy. 2007;27(8):1145-1152. 

In This Article

Improvements in the Suboptimal Use of Antiplatelet Therapies Identified by CRUSADE

Although the use of antiplatelet therapies is still not optimal for unstable angina and NSTEMI, the CRUSADE initiative has determined that the use of these agents is increasing in line with guideline recommendations. Between January 2001 and June 2003, GP IIb-IIIa inhibitors were used in 35% of eligible patients,[47] whereas during the 12-month period ending in the second quarter 2006, the proportion of eligible patients treated with GP IIb-IIIa inhibitors had risen to 46%.[30]

Similarly, the use of clopidogrel in both the early intervention and discharge settings has improved over time: between first quarter 2002 and third quarter 2004, the proportions of patients receiving clopidogrel in these settings were 42% and 57%, respectively. In second quarter 2006, the corresponding proportions of patients receiving clopidogrel in the early intervention and discharge settings were 60% and 73%, respectively. These trends are encouraging, but there is still a need for action to promote further use of class I guideline-recommended therapies and adherence to guideline recommendations in general.

In 2005, the CRUSADE initiative moved into the next phase of collaborative effort to bring about improvements in clinical and prescribing practices among patients with unstable angina or NSTEMI. The reach of the CRUSADE initiative is extending to primary care physicians through presentation of findings at appropriate internal medicine, family medicine, and hospital forums. The hospital pharmacist has an important role to play in both assisting with the treatment of patients with acute-phase unstable angina or NSTEMI and in ensuring provision of a continuum of care based on guideline recommendations as patients transition from hospital to community-based management.


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