Issues in antiplatelet therapy for UA/NSTEMI
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
References
- Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Unstable Angina). J Am Coll Cardiol. 2000;36:970–1062
[Free Full Text] - Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Unstable Angina). Circulation. 2000;102:1193–1209
[Free Full Text] - Bertrand ME, Simoons ML, Fox KAA, et al. Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation; recommendations of the Task Force of the European Society of Cardiology. (chair)Eur Heart J. 2000;21:1406–1432
[Free Full Text] - Simoons ML. GUSTO IV ACS (Global Utilisation of Streptokinase and t-PA for Occluded coronary arteries trial IV in Acute Coronary Syndromes): outcome of 7600 patients with acute coronary syndromes randomised to placebo or abciximab for 1 or 2 days. Amsterdam, The NetherlandsPresented at the 22nd Congress of the European Society of Cardiology. August 2000.
- Meade TW, Brennan PJ. Determination of who may derive most benefit from aspirin in primary prevention: subgroup results from a randomised controlled trial. Br Med J. 2000;321:13–17
[Abstract/Free Full Text] - Bolsano F, Rizzon P, Viola F, et al. Antiplatelet treatment with ticlopidine in unstable angina: a controlled multicenter clinical trial. The Studio della Ticlopidina nell'Angina Instabile Group. Circulation. 1990;82:17–26
[Abstract/Free Full Text] - Boersma E, Akkerhuis KM, Théroux P, et al. Platelet glycoprotein IIb/IIIa receptor inhibition in non-ST-elevation acute coronary syndromes: early benefit during medical treatment only, with additional protection during percutaneous coronary intervention. Circulation. 1999;100:2045–2048
[Abstract/Free Full Text] - Fox KM, et al. Management of high-risk unstable angina and non-ST-segment elevation myocardial infarction: variations in practice. Findings from the Global Registry of Acute Coronary Events (GRACE). The GRACE Investigators. Eur Heart J. 2000;21:246 (Abstr Suppl)
- Wallentin LC. GUSTO IV ACS (Global Utilisation of Streptokinase and t-PA for Occluded coronary arteries trial IV in Acute Coronary Syndromes): substudy comparing outcomes for the combination of abciximab with standard unfractionated heparin or low molecular weight heparin. Amsterdam, The NetherlandsPresented at the 22nd Congress of the European Society of Cardiology. August 2000.
- Ferguson JJ, Antman E, Bates E, et al. The use of enoxaparin and IIb/IIIa antagonists in acute coronary syndromes, including PCI: the NICE-3 study. Washington DC, USAPresented at Trans catheter Cardiovascular Therapeutics. 2000.
- Cairns JA, Théroux P, Lewis HD, Ezekowitz M, Meade TW, Sutton GC. Antithrombin agents in coronary artery disease. (chair)Chest. 1998;114:611S–633S (Suppl)[ISI][Medline]
- Braunwald E, Brown J, Brown L, et al. Unstable angina: diagnosis and management. Clinical practice guideline number 10. AHCPR Publication No. 94–0602. Rockville: US Department of Health and Human Services, Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute; 1994.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||