Document Detail


Developments in antiplatelet therapy for acute coronary syndromes and considerations for long-term management.
MedLine Citation:
PMID:  19419337     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This article reviews the currently available antiplatelet therapies and emerging investigational drugs in the treatment of acutecoronary syndrome (ACS), and considerations for primary and secondary prevention in the long-term management of ACS patients undergoing percutaneous coronary intervention (PCI). RESEARCH DESIGN AND METHODS: Primary studies and reviews in the peer-reviewed, English-language literature were identified through searches of MEDLINE (1966-2008) using the terms 'acute coronary syndrome', 'antiplatelet', 'aspirin', 'long-term management', 'P2Y(12) receptor', and 'thienopyridine'. Additional references were obtained by searching the reference lists of the identified articles. Articles were included if they were recently published and pertinent, patient-focused, and authors were recognized as leaders in the field. Current review is limited by literature search on single database. RESULTS: Platelets play a major role in atherogenesis and the formation of thrombi, the main events in the pathogenesis of ACS. Although aspirin is an effective antiplatelet agent, efficacy and safety data from a number of randomized clinical trials on atherothrombotic disease support the use of dual antiplatelet therapies such as aspirin and thienopyridines over single antiplatelet therapy for ACS and up to 1 year following ACS. Antiplatelet agents reduce, but do not eliminate, ischemic events after ACS due, in part, to variable individual response (or resistance) in antiplatelet agents, non-compliance, progression of atherosclerosis, modest inhibition of platelet aggregation (IPA) levels and other factors. Several antiplatelet agents, including novel P2Y(12)-receptor antagonists and thrombin-receptor antagonists, are currently under investigation for ACS and primary and secondary prevention in the long-term management of patients undergoing PCI. CONCLUSIONS: Current antiplatelet therapies have clinical benefits such as reducing immediate and long-term cardiovascular risk, but substantial residual risk remains indicating a need for new therapeutic agents. Additional large randomized trials are necessary to determine the most appropriate treatment regimens for ACS patients.
Authors:
Michael J Cowley; Louis Kuritzky
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Current medical research and opinion     Volume:  25     ISSN:  1473-4877     ISO Abbreviation:  Curr Med Res Opin     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2010-03-16     Completed Date:  2010-06-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0351014     Medline TA:  Curr Med Res Opin     Country:  England    
Other Details:
Languages:  eng     Pagination:  1477-90     Citation Subset:  IM    
Affiliation:
Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / drug therapy*,  surgery
Algorithms
Clinical Trials as Topic / methods,  trends*
Guidelines as Topic
Humans
Long-Term Care
Models, Biological
Platelet Aggregation Inhibitors / therapeutic use*
Pyridines / therapeutic use
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 0/Pyridines; 0/thienopyridine

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


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