PMID- 18653821
OWN - NLM
STAT- MEDLINE
DCOM- 20080902
LR  - 20190101
IS  - 1535-2900 (Electronic)
IS  - 1079-2082 (Linking)
VI  - 65
IP  - 15 Suppl 7
DP  - 2008 Aug 1
TI  - Optimizing antithrombotic therapy in patients with non-ST-segment elevation acute 
      coronary syndrome.
PG  - S22-8
LID - 10.2146/ajhp080242 [doi]
AB  - PURPOSE: Considerations in selecting antithrombotic and antiplatelet therapy for 
      patients with non-ST-segment elevation (NSTE) acute coronary syndrome (ACS), 
      including patients undergoing percutaneous coronary intervention (PCI), are 
      discussed, and case studies are used to illustrate. SUMMARY: Patients with NSTE 
      ACS for whom a conservative treatment strategy is selected should receive 
      enoxaparin, fondaparinux, or unfractionated heparin (UFH) as anticoagulant 
      therapy. In high-risk patients with NSTE ACS for whom an early invasive strategy 
      is planned, enoxaparin and UFH are the agents with the highest level of evidence 
      (evidence level A). Fondaparinux and bivalirudin can also be used, but they have 
      a lower level of evidence (evidence level B). Since fondaparinux use in patients 
      undergoing PCI has been associated with an increased risk for catheter-related 
      thrombosis, the use of fondaparinux in PCI patients should be limited. The use of 
      bivalirudin alone is as effective and has been associated with less bleeding than 
      the use of UFH or enoxaparin plus a glycoprotein (GP) IIb/ IIIa inhibitor in 
      patients with NSTE ACS who undergo PCI. No benefit has been shown from adding 
      bivalirudin to a GP IIb/ IIIa inhibitor. The role of GP IIb/IIIa inhibitors in 
      patients with NSTE ACS and elevated troponin levels who are undergoing PCI has 
      been well established, even for patients receiving high-dose clopidogrel. 
      Anti-platelet therapy with clopidogrel has been shown to reduce both acute and 
      chronic events in patients with NSTE ACS, including patients undergoing PCI. A 
      conventional 300-mg clopidogrel loading dose needs to be administered at least 
      six hours before PCI to achieve an adequate antiplatelet effect. A 600-mg loading 
      dose appears to shorten the time to achieve an adequate antiplatelet effect to 
      about two hours. CONCLUSION: The choice of anticoagulant and antiplatelet agents, 
      dose, and timing of administration can affect outcomes in patients with NSTE ACS.
FAU - Dobesh, Paul P
AU  - Dobesh PP
AD  - College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 
      68135-6045, USA. pdobesh@unmc.edu
FAU - Phillips, Katherine W
AU  - Phillips KW
FAU - Haines, Stuart T
AU  - Haines ST
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Am J Health Syst Pharm
JT  - American journal of health-system pharmacy : AJHP : official journal of the 
      American Society of Health-System Pharmacists
JID - 9503023
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
CIN - Am J Health Syst Pharm. 2008 Dec 15;65(24):2328-9; author reply 2329-30; 
      discussion 2330. PMID: 19052275
MH  - Acute Coronary Syndrome/*drug therapy
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Female
MH  - Fibrinolytic Agents/*administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*administration & dosage/adverse effects
EDAT- 2008/07/31 09:00
MHDA- 2008/09/03 09:00
CRDT- 2008/07/31 09:00
PHST- 2008/07/31 09:00 [pubmed]
PHST- 2008/09/03 09:00 [medline]
PHST- 2008/07/31 09:00 [entrez]
AID - 65/15_Supplement_7/S22 [pii]
AID - 10.2146/ajhp080242 [doi]
PST - ppublish
SO  - Am J Health Syst Pharm. 2008 Aug 1;65(15 Suppl 7):S22-8. doi: 10.2146/ajhp080242.