Excess Dosing of Antiplatelet and Antithrombin Agents in the Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes

摘要

Context Effective medical care assumes delivery of evidence-based medicines to appropriate patients with doses comparable to those studied.Objective To investigate dosing of unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), and glycoprotein llb/llla inhibitors, and the association between dosing and major outcomes.Design, Setting, and Participants A prospective observational analysis in 387 US academic and nonacademic hospitals of 30136 patients from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative Registry who had non-ST-segment elevation acute coronary syndromes (NSTE ACS) with chest pain and either positive electrocardiograms or cardiac biomarkers between January 1 and September 30, 2004.