Coronary heart disease is responsible for more than half of all cardiovascular events in individuals less than 75 years of age. Among cardiovascular diseases (CVD), acute coronary syndrome is associated with substantial morbidity and mortality and places a large financial burden on the
health care system. The Global Burden of Disease study estimate of agestandardized CVD death rate of 272 per 100,000 populations in India is higher than the global average of 235 per 100,000 populations. The World Health
Organization (WHO) has estimated that, with the current burden of CVD, India would lose $237 billion from the loss of productivity and spending on health care over a 10-year period (2005–2015). Drug utilization evaluation of anticoagulant drugs is essential considering the spectrum of use and associated risk with their therapy. Early risk stratification with the help of various risk scores can assist Clinicians in determining appropriate pharmacologic therapies.
The objectives of the present study were to evaluate anticoagulant use patterns, identify and assess various drug interactions and ADRs and also to assess the prognostic value of CRUSADE (Can Rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA guidelines) risk score in predicting risk of major bleeding among patients with acute coronary syndromes (ACS). A total of 122 patients of which 98 (80%) were males and 24 (20%) were females, from the Cardiology and General medicine department as per the inclusion criteria were included in this prospective, observational study conducted for duration of 10 months.
From the study, the mean age of the overall study population was found to be 55.63±10.02 and most predominant group was middle adulthood (34-59) 74(60.65%). Among the ACS patients, ST elevated myocardial infarction 103 (84.42%) was the most commonly found followed by Unstable angina and Non ST elevated myocardial infarction. The most common non modifiable risk factor was found to be males 98 (80%) and other modifiable risk factors was found to be diabetes, hypertension. Diabetes mellitus was the most common co-morbid condition among the study populations 30 (32.96%). and majority of patients has received antiplatelets 242(19.29%) followed by anti-ulcerative agents and anticoagulants. A total of 721 drug-drug interactions were identified. 439 (60.88%) interactions were major in severity.
Unfractionated heparin 114 (96.61%) was found to be most extensively prescribed anticoagulants followed by Enoxaparin. More number of patients was in the very low bleeding risk category ≥ 20 (36.88%). The major bleeding risk factors were Age (≥ 65yrs) followed by diabetes, Females etc. Patients at higher risk category are also at high risk of bleeding according to CRUSADE risk score.
The overall incidence of bleeding rates was found to be 8(6.55%). The bleeding rate was more in the CRUSADE risk category (> 40) (75%) and also in patients with ST elevated myocardial infarction (87.5%).
Across the ACS spectrum, CRUSADE risk score was able to identify patients at high bleeding risk and the future aspects of this research study can focus on the implementation of various bleeding reducing strategies including the dosage adjustments of anticoagulants based on international normalized ratio (INR) and activated partial thromboplastin time (ApTT) value, using alternative therapy with less bleeding risk, correcting bleeding risk factors, if possible
