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clinical practice

Prehospital clopidogrel use and STEMI management: a review

02 June 2021
Features
02 June 2021
Volume 13 · Issue 6

Abstract

Clopidogrel is an anticoagulant commonly used in the prehospital environment for the management of ST-elevation myocardial infarction (STEMI). Some ambulance services have incorporated this into their treatment regimens; however, others hold a variety of alternative pharmacological interventions. This study examines the pharmacological efficacy and safety of clopidogrel in the management of patients with STEMI and explores whether ambulance services should use the drug as part of standard practice. A literature review was conducted to identify articles relating to the administration of clopidogrel in the prehospital setting. Fourteen peer-reviewed journal articles were included in this review, together with and clinical practice guidelines from eight international ambulance jurisdictions. According to this review, clopidogrel has been deemed safe, effective and practical for widespread use in the prehospital environment for the management of STEMI, particularly where there are extended transport times to definitive care facilities. However, some disagreement has arisen over whether clopidogrel is a more favourable anticoagulant than ticagrelor and prasugrel. Anticoagulants such as clopidogrel should be strongly considered as a standard treatment regimen in the prehospital management of STEMI across international jurisdictions.

After completing this module, the paramedic will be able to:

Cardiovascular disease is a major cause of mortality worldwide, and is directly related to the development of acute coronary syndrome (ACS) and ST-elevation myocardial infarction (STEMI) (Jiang et al, 2015). Globally, cardiovascular diseases (CVDs) are the number one cause of death (World Health Organization, 2017). Within the 17.5 million individuals who die from CVDs, four out of five deaths are caused by heart attacks and strokes (World Health Organization, 2017). Approximately 30% of patients with ACS experience STEMI, which is associated with a 5–15% inhospital mortality rate (André et al, 2014; Vercellino, 2017: 2).

Platelet aggregation and subsequent formation of a thrombus are pertinent components of STEMI development, and this highlights the importance of pharmacological platelet inhibition in the treatment of this condition (Jiang et al, 2015; US Food and Drug Administration (USFDA), 2019).

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