Editorial
Pitié-Salpêtrière, 47 Bl de l'Hôpital, Paris, France 75013
* Corresponding author. Tel: +33 1 42 16 30 07; fax: +33 1 42 16 29 31. E-mail address: gilles.montalescot{at}psl.ap-hop-paris.fr
On 16 December 2006, a panel discussion was held in Roissy, France, that brought together leading experts on antiplatelet agents and the treatment of acute coronary syndromes (ACS) for a discussion on ‘Goals of Effective Platelet Inhibition’. Our purpose was to examine the results of recent clinical trials of antiplatelet agents so as to offer clinicians practical recommendations for their use in the treatment of ACS. This supplement to European Heart Journal offers the proceedings of our meeting in the form of articles based on the presentations.
The role of antiplatelet agents in the treatment of ACS has undergone significant changes over the past several years. Aspirin, thienopyridines, and glycoprotein (GP) IIb/IIIa inhibitors are now standard parts of the treatment of ST-elevation myocardial infarction, non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA), whether an early invasive or an initial conservative strategy is chosen. After years of use and numerous clinical trials, the role of aspirin for patients with ACS is well established. Many questions remain, however, on the optimal timing and duration of treatment with thienopyridines and GP IIb/IIIa inhibitors, how these agents should be used in combination, for which patients they are appropriate, and the variability in patient response. With the recent publication of new guidelines on the management of UA/NSTEMI by the European Society of Cardiology1 and the American College of Cardiology/American Heart Association,2 issues surrounding the effective use of antiplatelet agents have come into clearer focus. From the wealth of clinical trial data now available, the guidelines offer the practicing physician several options when using these agents, depending on the strategy chosen and the needs of the individual patient. Unfortunately, guidelines cannot anticipate every clinical situation and at times must advise the physician to rely on personal judgement. In this supplement we have drawn on the knowledge and experience of our expert panel to provide insights that will help the physician faced with such situations.
The topics we have chosen to address in this supplement include some of the most controversial issues in antiplatelet therapy. Patients with ACS require rapid risk stratification and choice of strategy; how the physician should administer antiplatelet agents when the patient's course of therapy is unknown is a common dilemma. How and when to administer thienopyridines and GP IIb/IIIa inhibitors to patients undergoing percutaneous coronary intervention and the duration of dual antiplatelet therapy after the procedure in patients who have received drug-eluting stents have been the subject of several trials and many editorials. Whether the occurrence of ischaemic events despite antiplatelet therapy should be thought of as drug resistance or treatment failure, whether changes in therapy can overcome resistance, and the clinical role of platelet function testing are the subjects of ongoing debate. As new antiplatelet agents become available, clinical trials will be needed to define their place in therapy. Finally, whether antiplatelet therapy should be stopped before invasive procedures that carry a risk of bleeding is a commonly asked question.
We hope that our survey of the literature and the expertise of our panel members can be of service to the health care professionals who must navigate these issues on a daily basis. We wish to thank the sponsors of the meeting, Daiichi Sankyo Europe GmbH and Eli Lilly and Company, for making this publication possible.
 |
Conflict of interest: |
|---|
 Top Conflict of interest: References |
|---|
G.M. declares he has received grant support from the following companies: sanofi-aventis, Eli Lilly, Guerbet, Pfizer, and Bristol-Myers Squibb.
G.M. has received consulting fees from sanofi-aventis, Eli Lilly, Bristol-Myers Squibb, Merck Sharp & Dohme, Proctor & Gamble, AstraZeneca, GlaxoSmithKline, The Medicines Company, and Schering-Plough. He has also received lecture fees from sanofi-aventis, Eli Lilly, Bristol-Myers Squibb, Merck Sharp & Dohme, GlaxoSmithKline, and Nycomed.
|
Footnotes |
|---|
The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal Supplement or of the European Society of Cardiology.
|
References |
|---|
|
TopConflict of interest:References |
|---|
- Bassand JP, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernandez-Aviles F, Fox KAA, Hasdai D, Ohman EM, Wallentin L, Wijns W. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: the Task Force for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes of the European Society of Cardiology. Eur Heart J (2007) 28:1–63.
[Free Full Text] - Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE II, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction). J Am Coll Cardiol (2007) 50:e1–e157.
[Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||