Ta80 acute coronary syndromes - clopidogrel: information for the public

NHS
National Institute for
Clinical Excellence
Clopidogrel in the treatment
of non-ST-segment-elevation
acute coronary syndrome
Understanding NICE guidance –
information for people with
non-ST-segment-elevation acute
coronary syndrome, their families
and carers, and the public
Information about NICE Technology Appraisal 80 Clopidogrel in the treatment of non-ST-segment-elevation acute
coronary syndrome
Understanding NICE guidance – information for people with
non-ST-segment-elevation acute coronary syndrome, their families
and carers, and the public
Issue date: July 2004
Review date: July 2007
To order copies
Copies of this booklet can be ordered from the NHS Response Line;
telephone 0870 1555 455 and quote reference number N0614. A
version in Welsh and English is also available, reference number
N0615. Mae fersiwn yn Gymraeg ac yn Saesneg ar gael hefyd, rhif
cyfeirnod N0615. The NICE technology appraisal on which this
information is based, Clopidogrel in the treatment of non-ST-
segment-elevation acute coronary syndrome, is available from the
NICE website (www.nice.org.uk/TA080guidance). A short version of
the guidance (a ‘quick reference guide’) is available from the
website (www.nice.org.uk/TA080quickrefguide) or from the NHS
Response Line, reference number N0613.
National Institute for
Clinical Excellence
MidCity Place71 High HolbornLondonWC1V 6NA Published by the National Institute for Clinical ExcellenceJuly 2004Typeset by Icon Design, EtonPrint on demand National Institute for Clinical Excellence, July 2004. All rights reserved.
This material may be freely reproduced for educational and not-for-profit purposes within the NHS. No reproduction by or for commercialorganisations is permitted without the express written permission of theInstitute.
Contents
What is NICE guidance?
What is non-ST-segment-elevation acute
coronary syndrome?
What is clopidogrel?
What has NICE recommended?
What should I do next?
Will NICE review its guidance?
Further information
What is NICE guidance?
The National Institute for Clinical Excellence(NICE) is part of the NHS. It produces guidance(recommendations) on the use of medicines,medical equipment, diagnostic tests and clinicaland surgical procedures within the NHS inEngland and Wales.
To produce this guidance, NICE looks at howwell the medicine, equipment or procedureworks and also how well it works in relation tohow much it costs. This process is called anappraisal. The appraisal process involves themanufacturer of the medicine or equipment forwhich guidance is being produced and theorganisations that represent the healthcareprofessionals, patients and carers who will beaffected by the guidance.
NICE was asked to look at the available evidenceon the use of clopidogrel for non-ST-segment-elevation acute coronary syndrome. NICE wasasked to provide guidance that will help theNHS in England and Wales decide whenclopidogrel should be used. Understanding NICE guidance – clopidogrel in the treatment of non-ST-segment-elevation acute coronary syndrome What is non-ST-segment-elevation
acute coronary syndrome?
Non-ST-segment-elevation acute coronarysyndrome is a medical term used to describe twoheart problems: • non-ST-segment-elevation myocardial infarction These both happen for the same reason, and thesymptoms are similar. Doctors find it difficult to tellone from the other until they get the results of apatient’s blood tests. The conditions are describedin the next sections.
Unstable angina
Angina happens if there’s not enough blood andoxygen getting to the heart. Like most of ourmuscles, the heart needs oxygen to work. The bloodpicks up oxygen from the lungs and then carries itback to the heart through blood vessels calledcoronary arteries. If these arteries have becomenarrow, there may be times when there’s notenough blood and oxygen getting to the heart andthis can cause symptoms (this is when the person hasan attack of their angina). For example, this mighthappen during exercise when the heart is workingharder than normal and needs more oxygen. Understanding NICE guidance – clopidogrel in the treatment of non-ST-segment-elevation acute coronary syndrome A person having an angina attack feels pain,heaviness or tightness in the centre of theirchest. This may spread to their arms, neck, jaw,back or stomach. Or sometimes, it’s just theseareas that are affected. Unstable angina is themedical term used to describe angina pain thathappens even if the person is resting or is doingsomething that doesn’t take much effort.
Unstable angina comes on quickly and it signalsthat something has just happened in the arterythat has made it more blocked than normal. Non-ST-segment-elevation myocardial
infarction (NSTEMI)
Non-ST-segment-elevation myocardial infarctionhappens for the same reasons as unstableangina. But in this case, so little blood andoxygen is able to get through a narrow coronaryartery that some of the heart tissue becomesdamaged because it has been starved of oxygen.
Like unstable angina, this comes on quickly, andthe person usually feels severe chest pain.
Understanding NICE guidance – clopidogrel in the treatment of non-ST-segment-elevation acute coronary syndrome What is clopidogrel?
People who have unstable angina or non-ST-segment-elevation myocardial infarction are atrisk of having a major heart attack. This happenswhen so little oxygen reaches the heart that partof it dies off. One of the aims of treating aperson with unstable angina or NSTEMI is toreduce the likelihood of this happening. The medicine clopidogrel helps to stop bloodclots forming in the arteries – it’s known as anantiplatelet drug. As blood clots could also block the coronary arteries, stopping them from happening is a way of stopping thingsgetting worse.
What has NICE recommended?
During the appraisal, NICE’s Appraisal Committeeread and heard evidence from: • doctors with specialist knowledge of non-ST- segment-elevation acute coronary syndromeand its treatment • individuals with specialist knowledge of the issues affecting people with non-ST-segment-elevation acute coronary syndrome Understanding NICE guidance – clopidogrel in the treatment of non-ST-segment-elevation acute coronary syndrome • organisations representing the views of people who will be affected by the guidance (becausethey have, or care for someone with, thecondition or because they work in the NHS andare involved in providing care for people withthe condition) The evidence is summarised in the full guidance(see end for details). More information about thestudies is provided in the assessment report forthis appraisal (see end for details).
NICE has made the following recommendationsabout the use of clopidogrel to treat non-ST-segment-elevation acute coronary syndromewithin the NHS in England and Wales.
Clopidogrel, together with a low dose of aspirin,should be used for people with non-ST-segment-elevation acute coronary syndrome who have amoderate to high risk of a major heart attack(myocardial infarction) or death.
Whether a person is at moderate to high risk of amajor heart attack can be judged from theirsymptoms and by one or both of the followingtest results. Understanding NICE guidance – clopidogrel in the treatment of non-ST-segment-elevation acute coronary syndrome • New ECG changes that show that the person’s heart is not receiving enough blood. (An ECG,or heart trace, is a test that shows how theheart is beating. Doctors can tell from thepattern on the ECG if there are problems.) • Blood tests that show that there has been Treatment with clopidogrel and low-dose aspirinshould be continued for up to 12 months afterthe most recent attack. After this time, doctorsshould give the normal treatment, which includesa low dose of aspirin.
What should I do next?
If you or someone you care for has non-ST-segment-elevation acute coronary syndrome,you should discuss this guidance with thespecialist looking after you or them. Will NICE review its guidance?
Yes. The guidance will be reviewed in July 2007.
Understanding NICE guidance – clopidogrel in the treatment of non-ST-segment-elevation acute coronary syndrome Further information
The NICE website (www.nice.org.uk) has furtherinformation about NICE and the full guidanceon clopidogrel in the treatment of non-ST-segment-elevation acute coronary syndromethat has been issued to the NHS. The assessmentreport, which contains details of the studies thatwere looked at, is also available from the NICEwebsite. A short version of the guidance (a ‘quick reference guide’) is available on thewebsite and from the NHS Response Line(telephone 0870 1555 455 and quote referencenumber N0613).
If you have access to the Internet, you can findmore information about heart conditions on theNHS Direct website (www.nhsdirect.nhs.uk). Youcan also phone NHS Direct on 0845 46 47. Understanding NICE guidance – clopidogrel in the treatment of non-ST-segment-elevation acute coronary syndrome NHS
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Source: http://www.staywell-angina.co.uk/angina_centre/angina/nice/TA080publicinfoenglish.pdf