Document Detail

Antithrombotic drugs in coronary artery disease: risk benefit ratio and bleeding.
MedLine Citation:
PMID:  20059668     Owner:  NLM     Status:  MEDLINE    
The antithrombotic treatment of coronary artery disease is becoming increasingly complex. Aspirin is often combined with more potent antiplatelet agents such as thienopyridines and glycoprotein IIb/IIIa inhibitors. The classic anticoagulant unfractionated heparin is giving way to low-molecular-weight heparin, the pentasaccharide fondaparinux and the direct thrombin inhibitor bivalirudin. Warfarin (or another vitamin K antagonist) and antiplatelet agents are often required in combination for several months. Patients and physicians who have experienced major bleeding complications sometimes question the benefit of these treatment strategies. It is therefore crucial to try and weigh the impact on efficacy against safety. In this review the net benefit is discussed both numerically, comparing absolute reductions vs. increases in risks, and also by addressing the qualitative importance of each component in reaching the net benefit. Except for primary prophylaxis in patients at low-moderate risk for coronary events, there is a net benefit of antithrombotic therapy. With increasing severity of the coronary condition the net benefit generally prevails even with an increasing number of antithrombotic drugs combined. However, as the patient slowly stabilizes after appropriate interventions, it is necessary to de-escalate the treatment in accordance with decreasing net benefit of prolonged combination therapy.
S Schulman; F A Spencer
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-01-06
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  8     ISSN:  1538-7836     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-19     Completed Date:  2010-07-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  England    
Other Details:
Languages:  eng     Pagination:  641-50     Citation Subset:  IM    
Department of Medicine, McMaster University and Henderson Research Center, Hamilton, ON, Canada.
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MeSH Terms
Angina, Unstable / blood,  drug therapy,  etiology
Angioplasty, Transluminal, Percutaneous Coronary
Anticoagulants / adverse effects*
Combined Modality Therapy
Coronary Artery Disease / blood,  complications,  drug therapy*
Drug Therapy, Combination
Evidence-Based Medicine
Fibrinolytic Agents / adverse effects*
Hemorrhage / chemically induced*
Myocardial Infarction / blood,  drug therapy,  etiology
Myocardial Ischemia / blood,  drug therapy*,  etiology
Patient Selection
Platelet Aggregation Inhibitors / adverse effects*
Risk Assessment
Risk Factors
Severity of Illness Index
Treatment Outcome
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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