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Antithrombotic therapy for acute coronary syndromes
Sarah A Spinler1, Stephanie M Inverso, Janet H Dailey
1Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, 600 South 43rd Street, Philadelphia, PA 19104, USA. s.spinler@usip.edu
Journal of the American Pharmacists Association : Japha
|April 21, 2004
Summary
This review highlights antithrombotic therapy for acute coronary syndromes (ACS). Immediate aspirin and reperfusion strategies like PCI or thrombolysis are crucial for ST-segment elevation ACS, while NSTE ACS management involves antiplatelets and anticoagulants.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Acute coronary syndromes (ACS) represent a spectrum of clinical presentations of myocardial infarction.
- Effective antithrombotic therapy is critical for managing ACS and improving patient outcomes.
Purpose of the Study:
- To review the current role and evidence for antithrombotic therapies in the hospital management of acute coronary syndromes.
- To provide guidance on optimal pharmacologic and interventional strategies for different ACS subtypes.
Main Methods:
- Systematic review of recent (1995-2003) scientific literature, including randomized clinical trials and review articles.
- Searches conducted using Medline with terms related to ACS, antithrombotic, and antiplatelet therapies.
Main Results:
- For ST-segment elevation (STE) ACS, immediate non-enteric-coated aspirin and rapid reperfusion via percutaneous coronary intervention (PCI) or thrombolysis are recommended.
- Patients undergoing primary PCI should receive glycoprotein IIb/IIIa inhibitors and anticoagulation; thrombolysis requires unfractionated heparin (UFH).
- For non-ST-segment elevation (NSTE) ACS, standard care includes beta-blockers, nitrates, antiplatelets (aspirin, clopidogrel), and antithrombins (UFH or low-molecular-weight heparin). Glycoprotein IIb/IIIa inhibitors benefit patients undergoing PCI.
Conclusions:
- Early reperfusion with thrombolytics or primary PCI is essential for STE ACS.
- Early invasive management is advised for high-risk NSTE ACS patients; early invasive or conservative therapy is suitable for lower-risk NSTE ACS patients.