September 23, 2003JAMA
Evaluation of Prolonged Antithrombotic Pretreatment ("Cooling-Off" Strategy) Before Intervention in Patients With Unstable Coronary Syndromes
Why the study?
Does prolonged antithrombotic pretreatment reduce the composite of large nonfatal myocardial infarction or death in patients with unstable coronary syndromes compared to early intervention?
Population
410 patients admitted to 2 German tertiary care centers with symptoms of unstable angina plus either…
Comparison
Prolonged antithrombotic pretreatment for 3 to 5… vs Early intervention after antithrombotic…
Design
RCT, Randomly allocated
Follow-up
30 days
Authors
Discussion
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Implication
Prolonged antithrombotic pretreatment increases death or large MI risk versus early intervention; challenges routine cooling-off before catheterization in unstable syndromes.
Structured PICO
Does prolonged antithrombotic pretreatment reduce the composite of large nonfatal myocardial infarction or death in patients with unstable coronary syndromes compared to early intervention?
P
Population
410 patients admitted to 2 German tertiary care centers with symptoms of unstable angina plus either ST-segment depression or elevation of cardiac troponin T levels.
I
Intervention
Prolonged antithrombotic pretreatment for 3 to 5 days before catheter intervention, consisting of intravenous unfractionated heparin, aspirin, oral clopidogrel, and intravenous tirofiban.
C
Comparator
Early intervention after antithrombotic pretreatment for less than 6 hours (receiving the same antithrombotic regimen).
O
Outcome
Composite 30-day incidence of large nonfatal myocardial infarction or death from any cause.composite
In patients with unstable coronary syndromes, a prolonged 'cooling-off' antithrombotic pretreatment strategy before intervention increases the risk of death or large MI compared to early intervention.
Cite This Study
Neumann et al. (2003) studied this question.