SCIENTIFIC JOURNAL of the Hungarian Society of Cardiology

Antiplatelet treatment of high-risk patients following acute coronary syndromes: treatment guidance of the Working Group on Thrombosis of the Hungarian Society of Cardiology implementing national reimbursement protocols

█ Guidelines

DOI: 10.26430/CHUNGARICA.2019.49.4.267

Aradi Dániel1,2, Komócsi András3, Kancz Sándor4, Nagy Gergely György5, Kiss Róbert Gábor6, Merkely Béla2
1Állami Szívkórház, Aktív Kardiológia Osztály, Balatonfüred
2Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest
3Pécsi Tudományegyetem, Szívgyógyászati Klinika, Pécs
4Gottsegen György Országos Kardiológiai Intézet, Felnőtt Kardiológiai Osztály, Budapest
5Borsod-Abaúj-Zemplén Megyei Központi Kórház és Egyetemi Oktatókórház, I. sz. Belgyógyászat – Kardiológiai Osztály, Miskolc
6Magyar Honvédség, Állami Egészségügyi Központ, Kardiológiai Osztály, Budapest


Dual antiplatelet treatment, which generally involves the administration of acetyl-salicylic acid combined with an ADP-receptor blocker for one year, plays a fundamental role in preventing recurrent ischemic events among patients after acute coronary syndromes (ACS). Current treatment guidelines of the European Society of Cardiology (ESC) prefer the routine administration of the more potent antiplatelet agent prasugrel or ticagrelor from the available ADP-receptor blockers for patients after an acute coronary event. Clopidogrel is recommended only, if the more effective drugs are contraindicated or not available. However, routine use of prasugrel or ticagrelor in Hungary have been restricted by reimbursement protocols for certain high-risk patient populations. The reimbursement regulations were favourably amended in recent years, which was a major step forward in the optimal antiplatelet treatment of these high-risk patients. However, the contradictions between the national financial protocols and the ESC professional guidelines often make it unclear which evidence the recommended antiplatelet therapy is based on in high-risk patient subgroups. To address this uncertainty, the Working Group on Thrombosis of the Hungarian Society of Cardiology prepared this consensus recommendation to review the relevant scientific evidence behind the antiplatelet treatment of selected high-risk populations of ACS and to provide guidance for routine clinical practice.


click here to read the full article

click here to read the pdf