Antiplatelet Strategies: Evaluating Their Current Role in the Setting of Acute Coronary Syndromes |
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| Authors: | Eugene Braunwald Dominick Angiolillo Eric Bates Peter B Berger Deepak Bhatt Christopher P Cannon Mark I Furman Paul Gurbel Alan D Michelson Eric Peterson Stephen Wiviott |
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| Institution: | 1. TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts;2. Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, Florida;3. Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan;4. Geisinger Center for Health Research, Danville, Pennsylvania;5. Department of Cardiovascular Medicine, Cardiovascular Coordinating Center, Cleveland Clinic, Cleveland, Ohio;6. Cardiovascular Medicine, South Shore Hospital, South Weymouth, Massachusetts;7. Department of Medicine, Sinai Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland;8. Center for Platelet Function Studies, Pediatrics, Medicine, and Pathology, University of Massachusetts Medical School, Worcester, Massachusetts;9. Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina, USA |
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| Abstract: | Numerous clinical trials have established the value of antiplatelet therapies for acute coronary syndromes (ACS). Aspirin (ASA), thienopyridines (i.e., clopidogrel and ticlopidine) and GP IIb/IIIa antagonists comprise the major classes of antiplatelet therapies demonstrated to be of benefit in the treatment of ACS and for the prevention of thrombotic complications of percutaneous coronary intervention (PCI). Clopidogrel is beneficial when administered before and after PCI, and is more effective when combined with either ASA or GP IIb/IIIa inhibitors in preventing post‐PCI complications, coronary subacute stent thrombosis, and thrombotic events in general. It is currently unclear whether a higher loading dose of clopidogrel (600 mg) is better than the standard loading dose (300 mg), how long therapy should continue, and which maintenance dose is optimal. The role of the GP IIb/IIIa antagonists in ACS is less clear due to conflicting data from several studies with different patient populations. Currently, it appears that the use of GP IIb/IIIa antagonists might be most beneficial in high‐risk ACS patients scheduled to undergo PCI, who demonstrate non‐ST‐segment elevation myocardial infarction and elevated troponin levels. Copyright © 2008 Wiley Periodicals, Inc. |
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| Keywords: | catheterization/diagnostic interventional> cardiac acute coronary syndromes> ischemic heart disease platelets thrombosis/hypercoagulable |
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