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[Current aspects of thrombolytic therapy in unstable angina pectoris]
1Zentrum für Innere Medizin, Abt. Innere Medizin-Kardiologie/Angiologie.
Insights
Acetylsalicylic acid is the standard treatment for unstable angina, reducing risks by 50%. Combining GP IIb/IIIa antagonists with reduced heparin offers significant benefits with minimal bleeding complications.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Unstable angina pectoris requires effective antithrombotic therapy.
- Numerous therapeutic agents have been investigated for managing this condition.
Purpose:
- To review the efficacy and safety of various antithrombotic drugs in unstable angina.
- To compare the clinical outcomes associated with different treatment strategies.
Summary:
- Acetylsalicylic acid remains the cornerstone treatment, reducing death and myocardial infarction by 50% in six months.
- Unfractionated heparin and low molecular weight-heparin show favorable effects, comparable to direct thrombin inhibitors.
- GP IIb/IIIa antagonists significantly enhance aspirin's efficacy, especially when combined with reduced heparin doses, minimizing bleeding risks.
- Plasminogen activators are not recommended due to potential adverse outcomes.
Impact:
- Provides a comprehensive overview of antithrombotic options for unstable angina.
- Informs clinical decision-making regarding optimal therapeutic combinations.
- Highlights the importance of balancing efficacy with reduced bleeding complications.
Abstract:
In the last years, several studies addressed the role of the different antithrombotic therapeutics in unstable angina pectoris. Acetylsalicylic acid still is the standard treatment reducing the rate of death and myocardial infarction by 50% in the first six months. Ticlopidin has no clinical effect in the first six days and therefore is not suited for treatment in the acute phase. Unfractionated heparin has an additional favourable effect when added to aspirin. Low molecular weight-heparin is at least as effective as UF-heparin. Direct thrombin-inhibitors (hirudin, hirudin-analoga) seem to be comparable to UF-heparin. Plasminogen-activators should not be given in unstable angina, as they show a tendency to worsen the clinical outcome. GP IIb/IIIa-antagonists (antibodies, synthetic antagonists) significantly improve the clinical effects of aspirin. When combined with a reduced dose of heparin, their favourable effect remains unchanged, while bleeding complications are reduced to a minimum.