The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome
Dublin Core
Title
The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome
Subject
aspirin, nitroglycerin, patients , STEMI, ECG
Description
Background: Both chewed aspirin and sublingual nitroglycerin are fast acting medications and reach therapeutic
levels within a few minutes. Current guidelines for managing acute coronary syndrome (ACS) do not recognize the
importance of the order or timing of administering aspirin and nitroglycerin. This retrospective study aimed to
examine if there was any benefit to the timing of giving aspirin before or after nitroglycerin in cases of ACS.
Methods: From the large National Emergency Medical Services Information System (NEMSIS) 2017 Version
database, 2594 patients with acute coronary syndrome were identified (based on chest pain and their ECG finding)
that received aspirin plus nitroglycerin in prehospital settings. Based on which medication was given first, the
patients were separated in 2 groups: an aspirin-first and a nitroglycerin-first group. The 2246 patients who received
aspirin first were further stratified based on the time between administration of aspirin and the first dose of
nitroglycerin. The other 348 patients who received nitroglycerin first were similarly stratified.
Results: In patients with STEMI ischemia, giving nitroglycerin 10 min after aspirin dosing (compared to giving them
simultaneously) leads to a greater than 20% reduction in need for additional nitroglycerin, a greater than 7%
decrease in subjective pain experienced by the patient and reduced need for additional opioids. The aspirin-first
group in total, had a 39.6% decrease in subjective pain experience after giving additional nitroglycerin compared to
nitroglycerin-first group.
Conclusion: In patients with ACS, this study found that giving nitroglycerin 10 min after aspirin was associated with
a reduction in subjective pain scores, as well as a reduced need for additional nitroglycerin or opioids. Future
prospective trials examining the timing of aspirin vs. nitroglycerin are needed to confirm these findings.
levels within a few minutes. Current guidelines for managing acute coronary syndrome (ACS) do not recognize the
importance of the order or timing of administering aspirin and nitroglycerin. This retrospective study aimed to
examine if there was any benefit to the timing of giving aspirin before or after nitroglycerin in cases of ACS.
Methods: From the large National Emergency Medical Services Information System (NEMSIS) 2017 Version
database, 2594 patients with acute coronary syndrome were identified (based on chest pain and their ECG finding)
that received aspirin plus nitroglycerin in prehospital settings. Based on which medication was given first, the
patients were separated in 2 groups: an aspirin-first and a nitroglycerin-first group. The 2246 patients who received
aspirin first were further stratified based on the time between administration of aspirin and the first dose of
nitroglycerin. The other 348 patients who received nitroglycerin first were similarly stratified.
Results: In patients with STEMI ischemia, giving nitroglycerin 10 min after aspirin dosing (compared to giving them
simultaneously) leads to a greater than 20% reduction in need for additional nitroglycerin, a greater than 7%
decrease in subjective pain experienced by the patient and reduced need for additional opioids. The aspirin-first
group in total, had a 39.6% decrease in subjective pain experience after giving additional nitroglycerin compared to
nitroglycerin-first group.
Conclusion: In patients with ACS, this study found that giving nitroglycerin 10 min after aspirin was associated with
a reduction in subjective pain scores, as well as a reduced need for additional nitroglycerin or opioids. Future
prospective trials examining the timing of aspirin vs. nitroglycerin are needed to confirm these findings.
Creator
Kristijan B. Todoroski
Publisher
BMC Emergency Medicine
Date
(2021) 21:137
Contributor
Fajar bagus W
Format
PDF
Language
English
Type
Text
Files
Collection
Citation
Kristijan B. Todoroski, “The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome,” Repository Horizon University Indonesia, accessed November 10, 2024, https://repository.horizon.ac.id/items/show/3922.