PMID- 21226633
OWN - NLM
STAT- MEDLINE
DCOM- 20110721
LR  - 20181201
IS  - 1744-7666 (Electronic)
IS  - 1465-6566 (Linking)
VI  - 12
IP  - 2
DP  - 2011 Feb
TI  - Antithrombotic therapy in ST-segment elevation myocardial infarction.
PG  - 213-23
LID - 10.1517/14656566.2010.518613 [doi]
AB  - INTRODUCTION: Anticoagulation is an integral part of both fibrinolytic therapy 
      and percutaneous intervention (PCI) in the reperfusion treatment of ST-segment 
      elevation AMI (STEMI). AREAS COVERED: This article reviews the choices of 
      adjunctive anticoagulation regimens. Readers will appreciate the complexities of 
      anticoagulation and the variable risk of clotting with ischemic/thrombotic 
      complications versus that of bleeding. Antiplatelet therapy with aspirin and 
      clopidogrel is recommended with fibrinolysis and PCI. Newer P2Y(12) inhibitors 
      such as prasugrel and ticagrelor have been shown to reduce cardiovascular death, 
      myocardial infarction (MI), stroke and stent thrombosis, as compared with 
      clopidogrel. Ticagrelor has also been shown to reduce mortality. Glycoprotein 
      IIb/IIIa inhibitors, by blocking the final pathway of platelet clumping with each 
      other through bridging with fibrinogen, have the ability to disaggregate 
      platelets, hence the potential for reducing thrombotic complications as well as 
      increasing bleeding in patients undergoing PCI bleeding risks. Enoxaparin reduces 
      death and MI compared with unfractionated heparin (UFH) with fibrinolytic 
      therapy. There was a trend for a reduction in death, MI procedural failure or 
      non-coronary artery bypass grafting (CABG) major bleeding compared with UFH in 
      primary PCI. In primary PCI, bivalirudin has the advantage over UFH of inhibiting 
      clot bound thrombin and reduces bleeding and mortality compared with the use of 
      UFH plus glycoprotein IIb/IIIa inhibitors. Combinations of P2Y(12) antagonists 
      and bivalirudin need to be tested to optimize the balance between efficacy and 
      bleeding. EXPERT OPINION: This field is rapidly evolving with multiple 
      appropriate approaches.
FAU - Wong, Cheuk-Kit
AU  - Wong CK
AD  - University of Otago, Dunedin School of Medicine, New Zealand.
FAU - White, Harvey D
AU  - White HD
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - Expert Opin Pharmacother
JT  - Expert opinion on pharmacotherapy
JID - 100897346
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Polysaccharides)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
MH  - Angioplasty, Balloon, Coronary
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Coronary Thrombosis/*drug therapy
MH  - Electrocardiography
MH  - Enoxaparin/adverse effects/therapeutic use
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Fondaparinux
MH  - Hemorrhage/chemically induced/therapy
MH  - Humans
MH  - Myocardial Infarction/*drug therapy/mortality/physiopathology/therapy
MH  - Platelet Aggregation Inhibitors/adverse effects/*therapeutic use
MH  - Polysaccharides/adverse effects/therapeutic use
MH  - *Thrombolytic Therapy
EDAT- 2011/01/14 06:00
MHDA- 2011/07/22 06:00
CRDT- 2011/01/14 06:00
PHST- 2011/01/14 06:00 [entrez]
PHST- 2011/01/14 06:00 [pubmed]
PHST- 2011/07/22 06:00 [medline]
AID - 10.1517/14656566.2010.518613 [doi]
PST - ppublish
SO  - Expert Opin Pharmacother. 2011 Feb;12(2):213-23. doi: 
      10.1517/14656566.2010.518613.