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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Non-ST-elevation acute coronary syndromes management: a fresh look at glycoprotein IIb/IIIa inhibitors

Claudio Cavallini* and Fabio Chirillo

Division of Cardiology, Ca' Foncello Hospital, Treviso, Italy

* Corresponding author. Tel: +39 0422 322767; fax: +39 0422 322662. E-mail address: clcaval{at}tin.it

Several randomized clinical trials have shown glycoprotein (GP) IIb/IIIa inhibition to be beneficial in non-ST-segment elevation acute coronary syndromes (NSTE-ACSs), producing a significant reduction in the risk of death and myocardial infarction. The greatest benefit was found in high-risk patients, such as those with diabetes, those with a positive troponin value at baseline or those undergoing early percutaneous coronary intervention. Data from large national registries have shown that early use of GP IIb/IIIa inhibitors is associated with a benefit consistent with that reported in clinical trials, the lowest adjusted rate of in-hospital mortality was found for hospitals with the highest rate of early use of these drugs. Upstream treatment with small-molecule GP IIb/IIIa inhibitors, in combination with an early aggressive interventional approach, is clearly beneficial and is strongly recommended by international guidelines in high-risk patients with NSTE-ACS. However, GP IIb/IIIa inhibitors appear to be markedly underused in current practice. Potential reasons for this inconsistency are discussed.

Key Words: Unstable angina • Coronary thrombosis • Platelets • GP IIb/IIIa inhibitors • Coronary angioplasty • Guidelines


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