Document Detail


Balancing the benefits and risks of antiplatelet agents in patients with non-ST-segment elevated acute coronary syndromes and undergoing percutaneous coronary intervention.
MedLine Citation:
PMID:  20111983     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Jorge F Saucedo
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Journal of thrombosis and thrombolysis     Volume:  30     ISSN:  1573-742X     ISO Abbreviation:  J. Thromb. Thrombolysis     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-26     Completed Date:  2010-11-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9502018     Medline TA:  J Thromb Thrombolysis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  200-9     Citation Subset:  IM    
Affiliation:
University of Oklahoma Health Sciences Center, 920 Stanton L Young Boulevard, Oklahoma City, OK 73104, USA. Jorge-Saucedo@ouhsc.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / 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:
0/Platelet Aggregation Inhibitors

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


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