The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome

Abstract 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 nitrog...

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Autor principal:	Kristijan B. Todoroski
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/976c092431ca460993267736f309585c
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spelling	oai:doaj.org-article:976c092431ca460993267736f309585c2021-11-21T12:14:36ZThe timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome10.1186/s12873-021-00523-21471-227Xhttps://doaj.org/article/976c092431ca460993267736f309585c2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12873-021-00523-2https://doaj.org/toc/1471-227XAbstract 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.Kristijan B. TodoroskiBMCarticleSpecial situations and conditionsRC952-1245Medical emergencies. Critical care. Intensive care. First aidRC86-88.9ENBMC Emergency Medicine, Vol 21, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Kristijan B. Todoroski The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome
description	Abstract 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.
format	article
author	Kristijan B. Todoroski
author_facet	Kristijan B. Todoroski
author_sort	Kristijan B. Todoroski
title	The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome
title_short	The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome
title_full	The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome
title_fullStr	The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome
title_full_unstemmed	The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome
title_sort	timing of administering aspirin and nitroglycerin in patients with stemi ecg changes alter patient outcome
publisher	BMC
publishDate	2021
url	https://doaj.org/article/976c092431ca460993267736f309585c
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The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome

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