Balancing the benefits and risks of antiplatelet agents in patients with non-ST-segment elevated acute coronary syndromes and undergoing percutaneous coronary intervention.

Journal of Thrombosis and Thrombolysis
Jorge F Saucedo

Abstract

Selecting appropriate antiplatelet therapy requires close attention to the delicate balance between reducing risk of ischemic events while minimizing bleeding risk. The broad range of available agents, while permitting tailoring of pharmacotherapy to individual patients, also complicates selection of optimal regimens. Platelet physiology provides an underpinning for the rationale behind pharmacotherapeutic strategies for patients with non-ST-segment elevated acute coronary syndromes (NSTE ACS) undergoing percutaneous coronary intervention (PCI). The same mechanisms of action that confer anti-ischemic benefit with antiplatelet agents may also be associated with increased risk. In the context of ACS and PCI, antiplatelet agents are used in complex strategies and combinations with other pharmacotherapies targeted at alleviating ischemic symptoms and reducing ischemic risk. Accounting for individual patient risk factors, timing of treatment, and dosage of antiplatelet medications minimizes risk while optimizing outcomes. This review examines results from clinical trials of thienopyridines (clopidogrel, ticlopidine, and the newer prasugrel), the new P2Y(12) antagonists ticagrelor and cangrelor, glycoprotein IIb-IIIa inhibitors (abci...Continue Reading

References

Jun 12, 1997·The New England Journal of Medicine·UNKNOWN EPILOG Investigators
May 23, 1998·The New England Journal of Medicine·UNKNOWN Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS)
May 23, 1998·The New England Journal of Medicine·UNKNOWN Platelet Receptor Inhibition in Ischemic Syndrome Management (PRISM) Study Investigators
Aug 15, 1998·The New England Journal of Medicine·UNKNOWN Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial Investigato
Jan 6, 2001·Lancet·UNKNOWN ESPRIT Investigators. Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy
Aug 25, 2001·The New England Journal of Medicine·S YusufUNKNOWN Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators
Aug 25, 2001·Lancet·S R MehtaUNKNOWN Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators
Sep 19, 2001·JAMA : the Journal of the American Medical Association·A T HirschW R Hiatt
Jun 11, 2002·Journal of Interventional Cardiology·Lisa K JenningsMelanie McCabe White
Sep 25, 2002·Journal of Internal Medicine·P JäremoA Richter
Feb 7, 2003·Journal of the American College of Cardiology·Evangelia KarvouniJohn P A Ioannidis
Sep 16, 2003·The American Journal of Cardiology·David F KongRobert M Califf
Jan 16, 2004·The New England Journal of Medicine·Adnan KastratiUNKNOWN Intracoronary Stenting and Antithrombotic Regimen-Rapid Early Action for Coronary Treatment Study Investigators
May 3, 2005·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·James W HoekstraW Brian Gibler
Nov 16, 2005·Journal of the American College of Cardiology·Paul A GurbelUdaya S Tantry
Dec 29, 2005·JAMA : the Journal of the American Medical Association·Karen P AlexanderUNKNOWN CRUSADE Investigators
Nov 25, 2006·The New England Journal of Medicine·Gregg W StoneUNKNOWN ACUITY Investigators
Dec 26, 2006·Expert Review of Cardiovascular Therapy·Marco Cattaneo
Aug 3, 2007·Interactive Cardiovascular and Thoracic Surgery·Feza NurozlerCandan Okten

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Citations

Mar 2, 2012·Expert Review of Gastroenterology & Hepatology·Michael C WallaceGeoffrey M Forbes

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