PMID- 18690336
OWN - NLM
STAT- MEDLINE
DCOM- 20081008
LR  - 20080811
IS  - 0340-6245 (Print)
IS  - 0340-6245 (Linking)
VI  - 100
IP  - 2
DP  - 2008 Aug
TI  - Advances in antithrombotic therapy as adjunct to reperfusion therapies for 
      ST-segment elevation myocardial infarction.
PG  - 184-95
AB  - The treatment of ST-segment elevation myocardial infarction (STEMI) has improved 
      over the past decades, mainly due to reperfusion therapies. The aim of this 
      article is to provide an updated review of adjunctive antithrombotic therapy to 
      reperfusion strategies for STEMI. As compared to unfractionated heparin (UFH), 
      among patients treated with thrombolysis, low-molecular-weight heparins (LMWHs), 
      mainly enoxaparin, fondaparinux and clopidogrel have been shown to improve 
      outcome in terms of death and reinfarction, whereas GP IIb-IIIa inhibitors, 
      mainly abciximab, and direct thrombin inhibitors have reduced reinfarction, but 
      not mortality. Among patients undergoing primary angioplasty, early UFH should 
      still be regarded as the gold standard in anticoagulation therapy. In addition to 
      ASA, early GP IIb-IIIa inhibitors, especially abciximab, should be considered 
      since it has been shown to provide further benefits in terms of preprocedural 
      recanalization. Despite the positive results observed in the HORIZONS trial, 
      additional studies are needed to investigate the role of bivalirudin as compared 
      to abciximab administration. In our opinion, bivalirudin may be considered 
      instead of GP IIb-IIIa inhibitors among STEMI patients at high risk for bleeding 
      complications. Due to the very low mortality currently achieved by primary 
      angioplasty, a further reduction in short- or medium-term mortality would be 
      quite improbable to be observed. Thus, additional endpoints, such as infarct size 
      and myocardial perfusion, may be considered in future randomized trials among 
      patients undergoing mechanical revascularization for STEMI.
FAU - De Luca, Giuseppe
AU  - De Luca G
AD  - Division of Cardiology, Maggiore della Carita Hospital, Eastern Piedmont 
      University A Avogadro, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it
FAU - Marino, Paolo
AU  - Marino P
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 0 (Fibrinolytic Agents)
SB  - IM
MH  - Combined Modality Therapy
MH  - Electrocardiography
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*drug therapy
MH  - *Myocardial Reperfusion
RF  - 144
EDAT- 2008/08/12 09:00
MHDA- 2008/10/09 09:00
CRDT- 2008/08/12 09:00
PHST- 2008/08/12 09:00 [pubmed]
PHST- 2008/10/09 09:00 [medline]
PHST- 2008/08/12 09:00 [entrez]
AID - 08080184 [pii]
PST - ppublish
SO  - Thromb Haemost. 2008 Aug;100(2):184-95.