| Balancing the benefits and risks of antiplatelet agents in patients with non-ST-segment elevated acute coronary syndromes and undergoing percutaneous coronary intervention. | |
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MedLine Citation:
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PMID: 20111983 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Selecting appropriate antiplatelet therapy requires close attention to the delicate balance between reducing risk of ischemic events while minimizing bleeding risk. The broad range of available agents, while permitting tailoring of pharmacotherapy to individual patients, also complicates selection of optimal regimens. Platelet physiology provides an underpinning for the rationale behind pharmacotherapeutic strategies for patients with non-ST-segment elevated acute coronary syndromes (NSTE ACS) undergoing percutaneous coronary intervention (PCI). The same mechanisms of action that confer anti-ischemic benefit with antiplatelet agents may also be associated with increased risk. In the context of ACS and PCI, antiplatelet agents are used in complex strategies and combinations with other pharmacotherapies targeted at alleviating ischemic symptoms and reducing ischemic risk. Accounting for individual patient risk factors, timing of treatment, and dosage of antiplatelet medications minimizes risk while optimizing outcomes. This review examines results from clinical trials of thienopyridines (clopidogrel, ticlopidine, and the newer prasugrel), the new P2Y(12) antagonists ticagrelor and cangrelor, glycoprotein IIb-IIIa inhibitors (abciximab, eptifibatide, tirofiban), and the direct thrombin inhibitor bivalirudin. Recommendations include clopidogrel for use upstream if discontinued 5 days before coronary angiographic bypass graft. Bivalirudin remains a reasonable treatment choice in patients at low to moderate risk; and glycoprotein IIb-IIIa inhibitors confer anti-ischemic benefit with little incremental bleeding risk when individual patient factors are taken into account for their dosing. Increased awareness of the factors contributing to risks and benefits associated with the available antiplatelet agents will help guide physicians in choosing optimal regimens for all patients. |
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Authors:
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Jorge F Saucedo |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Journal of thrombosis and thrombolysis Volume: 30 ISSN: 1573-742X ISO Abbreviation: J. Thromb. Thrombolysis Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-26 Completed Date: 2010-11-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9502018 Medline TA: J Thromb Thrombolysis Country: Netherlands |
Other Details:
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Languages: eng Pagination: 200-9 Citation Subset: IM |
Affiliation:
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University of Oklahoma Health Sciences Center, 920 Stanton L Young Boulevard, Oklahoma City, OK 73104, USA. Jorge-Saucedo@ouhsc.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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drug therapy,
mortality,
therapy* Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects, mortality Evidence-Based Medicine Hemorrhage / chemically induced Humans Myocardial Ischemia / etiology, mortality, prevention & control* Patient Selection Platelet Aggregation Inhibitors / adverse effects, therapeutic use* Practice Guidelines as Topic Risk Assessment Risk Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Platelet Aggregation Inhibitors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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