PMID- 15095932
OWN - NLM
STAT- MEDLINE
DCOM- 20040505
LR  - 20191108
IS  - 1544-3191 (Print)
IS  - 1086-5802 (Linking)
VI  - 44
IP  - 2 Suppl 1
DP  - 2004 Mar-Apr
TI  - Antithrombotic therapy for acute coronary syndromes.
PG  - S14-26; quiz S26-7
AB  - OBJECTIVES: To review the role of antithrombotic therapy for treatment of acute 
      coronary syndromes (ACS) in the hospital setting. DATA SOURCES: Recent 
      (1995-2003) published scientific literature, as identified by the authors through 
      Medline searches, using the terms acute coronary syndromes, antithrombotic, 
      antiplatelet, clinical trials, and reviews on treatment. STUDY SELECTION: Recent 
      systematic English-language review articles and reports of controlled randomized 
      clinical trials were screened for inclusion. DATA SYNTHESIS: For the patient with 
      ST-segment elevation (STE) ACS, nonenteric-coated aspirin should be initiated 
      immediately, if possible before arrival at the emergency department. In-hospital 
      treatment is aimed at rapidly re-establishing coronary patency by means of 
      percutaneous coronary intervention (PCI) or thrombolysis, preventing cardiac 
      complications, and improving survival. Patients undergoing primary PCI should 
      receive a glycoprotein IIb/IIIa receptor inhibitor, unfractionated heparin (UFH), 
      and clopidogrel (Plavix--Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership) 
      if bypass surgery is not urgently indicated; those undergoing thrombolysis should 
      receive UFH. For the patient with non-ST-segment elevation (NSTE) ACS, 
      beta-blockers, nitrates (also indicated for STE myocardial infarction), 
      antiplatelet agents, and antithrombin therapy (UFH or low-molecular-weight 
      heparin) are provided in standard care. Aspirin should be commenced immediately 
      and continued indefinitely; in addition, clopidogrel is recommended for patients 
      who are medically managed and those undergoing PCI. Glycoprotein IIb/IIIa 
      receptor inhibitors (tirofiban [Aggrastat--Guilford Pharmaceuticals], 
      eptifibatide [Integrilin--Millennium Pharmaceuticals], and abciximab 
      [ReoPro--Lilly]) are of benefit in reducing ischemic complications in patients 
      undergoing PCI. CONCLUSION: Early reperfusion with thrombolytics or primary PCI 
      is required in patients presenting with STE ACS. Early invasive management is 
      recommended for high-risk patients with NSTE ACS; for lower-risk patients, either 
      early invasive or early conservative therapy is recommended.
FAU - Spinler, Sarah A
AU  - Spinler SA
AD  - Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, 600 
      South 43rd Street, Philadelphia, PA 19104, USA. s.spinler@usip.edu
FAU - Inverso, Stephanie M
AU  - Inverso SM
FAU - Dailey, Janet H
AU  - Dailey JH
FAU - Cziraky, Mark J
AU  - Cziraky MJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - J Am Pharm Assoc (2003)
JT  - Journal of the American Pharmacists Association : JAPhA
JID - 101176252
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Acute Disease
MH  - Angioplasty, Balloon
MH  - Coronary Disease/diagnosis/*drug therapy/surgery
MH  - Drug Therapy, Combination
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Humans
MH  - Inpatients
MH  - Monitoring, Physiologic
MH  - Platelet Aggregation Inhibitors/adverse effects/*therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Thrombolytic Therapy/adverse effects
MH  - Triage
RF  - 52
EDAT- 2004/04/21 05:00
MHDA- 2004/05/07 05:00
CRDT- 2004/04/21 05:00
PHST- 2004/04/21 05:00 [pubmed]
PHST- 2004/05/07 05:00 [medline]
PHST- 2004/04/21 05:00 [entrez]
AID - S1544-3191(15)31853-7 [pii]
AID - 10.1331/154434504322904578 [doi]
PST - ppublish
SO  - J Am Pharm Assoc (2003). 2004 Mar-Apr;44(2 Suppl 1):S14-26; quiz S26-7. doi: 
      10.1331/154434504322904578.