This review discusses the rationale and clinical use of newer antithrombotic therapies, such as ADP inhibitors, GP IIb-IIIa inhibitors, LMWH, and direct thrombin inhibitors, as alternatives or adjuncts to traditional aspirin and heparin in acute coronary syndromes.
May guide antithrombotic selection in ACS; leaves open optimal regimens pending randomized trials.
Prevention and management of acute coronary syndromes (ACS) are focal points of interest among health care providers. Acute coronary syndromes is an all-encompassing term that refers to unstable angina, non-Q wave myocardial infarction, and Q wave myocardial infarction. These syndromes are usually the result of atherosclerotic plaque rupture leading to thrombus formation in a coronary artery. Heparin and aspirin are traditional antithrombotic treatments. They typically are administered with antiischemic therapies and often with fibrinolytic agents for patients with ST segment elevation associated with acute myocardial infarction. Although aspirin and heparin are important, they have significant limitations that have prompted development of newer antithrombotic approaches. Adenosine diphosphate inhibitors have been evaluated as either alternatives or adjunctive treatment to aspirin. Glycoprotein IIb-IIIa receptor inhibitors, low-molecular-weight heparins, and direct thrombin inhibitors have been studied as concurrent therapy with, or as alternatives to, heparin.
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Wiggins et al. (2001) studied this question.
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