Alkem

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CLOT Study

A Retrospective Cohort Study of usage of Novel Oral Anticoagulants and Antiplatelets in Patients with Acute Coronary Syndrome (CLOT study)

BASIC DETAILS

Patient code (Do not write name here) *

Date *

Acute Coronary Syndrome

Diagnosis *

Yes No

Demographics and risk factors

Patient's Age (years) *

Gender *

Male Female Other

Height (in cm) *

Weight (in Kg) *

BMI *

Underweight (< 18.5 kg/m²)

Normal BMI (18.5-22.9 kg/m²)

Overweight (23.0 -24.9 kg/m²)

Obese (≥25 kg/m²)

Comorbid condition (mention Tick as applicable) *

Hypertension T2DM Heart Failure Dyslipidemia Chronic kidney disease Stroke Transient ischemic attack (TIA) Any Other

Family History of CVDs *

Yes

Smoking History *

Regular

Former

Never

{{-- need to create separate radio buttons for Smoking or Alcohol History --}}

Alcohol History *

Regular

Former

Never

Clinical Assessment

Presenting Symptoms

Describe symptoms at presentation*

Vital Signs

Blood Pressure (mmHg)

Heart Rate (bpm)

Blood Biochemical Measurements (if available)

Troponin Levels

Troponin I (ng/mL)

Troponin T (ng/mL)

Cardiac Enzymes

Creatine Kinase (CK) (U/L)

CK-MB (U/L)

Medication History

Novel Oral Anticoagulant Treatment *

	Dosage	Duration of treatment1 (weeks)	Dose (mg)
Apixaban	OD BID TID
Dabigatran	OD BID TID
Rivaroxaban	OD BID TID
Warfarin	OD BID TID
At least one radio button for "Novel Oral Anticoagulant Treatment" must be selected.

Antiplatelet Treatment *

	Dosage	Duration of treatment1 (weeks)	Dose (mg)
Ticagrelor	OD BID TID
Aspirin	OD BID TID
Clopidogrel	OD BID TID
Prasugrel	OD BID TID
At least one radio button for "Antiplatelet Treatment" must be selected.

Anti Hypertensives *

Yes

Lipid lowering *

Yes

Revascularization Procedure done

PCI

CABG

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