Key result
Risk stratification is necessary to balance ischemic event reduction and bleeding risks when using glycoprotein IIb-IIIa inhibitors and bivalirudin in patients with ACS undergoing PCI.
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This review highlights the importance of risk stratification in ACS patients undergoing PCI to appropriately balance the ischemic benefits and bleeding risks of intensive antithrombotic therapies.
Appropriate pharmacologic treatment for patients with acute coronary syndromes (ACS) remains a matter of controversy. Additionally, a substantial gap exists between recommended guidelines and current clinical practice. Questions remain regarding which antiplatelet/antithrombotic treatment strategies are appropriate for individual patients, based on their risk. We explore the role of glycoprotein IIb-IIIa inhibitors and the direct thrombin inhibitor bivalirudin in ACS patients, and consider the difficulties involved in reducing ischemic events while limiting bleeding risks. In patients with ACS who are undergoing percutaneous coronary intervention, high levels of microembolization and myocardial necrosis are potential risk factors for adverse long-term outcomes. Intensive antiplatelet/antithrombotic regimens may substantially affect these factors. Determination of risk levels, with the goal of targeting aggressive antithrombotic and interventional therapies to patients at higher risk, will help physicians choose appropriate pharmacologic therapy for patients with ACS.
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Kwa et al. (2008) conducted a review in Acute coronary syndromes (ACS). Glycoprotein IIb-IIIa inhibitors and bivalirudin was evaluated. Risk stratification is necessary to balance ischemic event reduction and bleeding risks when using glycoprotein IIb-IIIa inhibitors and bivalirudin in patients with ACS undergoing PCI.
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