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Issues in antiplatelet therapy for UA/NSTEMI

K. Chatterjee*,1, J. Col2, A.J. Dalby3 and D. Gulba4

1 UCSF Moffitt-Long Hospital, San Francisco, California, USA
2 Cliniques Universitaires Saint-Luc, Brussels, Belgium
3 Milpark Hospital, Johannesburg, South Africa
4 Franz-Volhard-Klinik, Berlin, Germany

* Correspondence: Kanu Chatterjee, UCSF Moft-Long Hospital, San Francisco, California, USA

Abstract

Options for antiplatelet therapy have increased in the last decade, with thienopyridines and GP IIb/IIIa receptor antagonists joining aspirin on the roster of available antiplatelet agents. Both North American (ACC/AHA) and European (ESC) cardiology societies have made recommendations regarding the use of antiplatelet agents in recently issued practice guidelines for the management of acute coronary syndromes without ST-segment elevation. In September 2000, a group of international cardiologists meeting under the auspices of the International Cardiology Forum participated in a workshop to examine the new antiplatelet recommendations. Workshop participants generally agreed that both sets of guidelines were satisfactory, however there were areas of disagreement. The most controversial topic was the role of GP IIb/IIIa antagonists. Given the evidence for efficacy of these agents for medical management, many participants felt that their use was overemphasized. There was strong support for the use of GP IIb/IIIa inhibitors in the setting of intervention, although cost is prohibitive in many countries. In view of real-world limitations, guidelines for alternative management strategies are needed.

Key Words: Antiplatelet • GP IIb/IIIa antagonist • acute coronary syndromes • unstable angina • guidelines


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