Open AccessAntiplatelet Strategies: Evaluating Their Current Role in the Setting of Acute Coronary Syndromes
Author(s) -
Braunwald Eugene,
Angiolillo Dominick,
Bates Eric,
Berger Peter B.,
Bhatt Deepak,
Can Christopher P.,
Furman Mark I.,
Gurbel Paul,
Michelson Alan D.,
Peterson Eric,
Wiviott Stephen
Publication year - 2008
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.20362
Subject(s) - medicine , clopidogrel , percutaneous coronary intervention , conventional pci , ticlopidine , acute coronary syndrome , aspirin , cardiology , myocardial infarction , loading dose , tirofiban
Numerous clinical trials have established the value of antiplatelet therapies for acute coronary syndromes (ACS). Aspirin (ASA), thienopyridines (i.e., clopidogrel and ticlopidine) and GP IIb/IIIa antagonists comprise the major classes of antiplatelet therapies demonstrated to be of benefit in the treatment of ACS and for the prevention of thrombotic complications of percutaneous coronary intervention (PCI). Clopidogrel is beneficial when administered before and after PCI, and is more effective when combined with either ASA or GP IIb/IIIa inhibitors in preventing post‐PCI complications, coronary subacute stent thrombosis, and thrombotic events in general. It is currently unclear whether a higher loading dose of clopidogrel (600 mg) is better than the standard loading dose (300 mg), how long therapy should continue, and which maintenance dose is optimal. The role of the GP IIb/IIIa antagonists in ACS is less clear due to conflicting data from several studies with different patient populations. Currently, it appears that the use of GP IIb/IIIa antagonists might be most beneficial in high‐risk ACS patients scheduled to undergo PCI, who demonstrate non‐ST‐segment elevation myocardial infarction and elevated troponin levels. Copyright © 2008 Wiley Periodicals, Inc.