When a patient presents with an ACS, the initial treatment is necessarily empiric. As the exact nature of the disease and the eventual treatment strategy are not known, the initial management has to include patients who will undergo invasive procedures as well as those who will be treated medically. As the decision to perform catheterization is usually made more than 24 hours after presentation, beneficial therapies should not be withheld until angiographic results are known. When patients with unstable coronary syndromes undergo percutaneous interventions, clinical events are happening both before and during the intervention, and effective antiplatelet therapy can prevent these events from occurring. In clinical settings corresponding to methods of management used in North American centers, GP IIb-IIIa inhibition has been shown to be effective both for those patients who will undergo interventional procedures and for those who will be treated medically. In patients with ACS, if the decision to perform an intervention is made, pretreatment with GP IIb-IIIa inhibitors may be helpful in reducing the thrombus burden. However, a delay in performing PCI does not seem to be absolutely necessary, at least if the GP IIb-IIIa inhibitor of choice is abciximab or eptifibatide. It should be noted that some of the above conclusions are based on comparisons of nonrandomized subgroups, and that randomized studies are needed in order to provide definitive answers about the optimal timing and duration of GP IIb-IIIa inhibition in the setting of ACS. All three GP IIb-IIIa inhibitors have been proven safe and efficacious in clinical trials, and comparisons between the agents are impossible to make without head-to-head studies. Therefore, these agents should be used according to approved indications, based on evidence obtained from clinical studies. Finally, determining the risk for adverse events is extremely difficult. Currently available data argue that therapy with GP IIb-IIIa inhibitors should be part of the initial management of all patients with non- ST-segment elevation ACS.
|Original language||English (US)|
|Number of pages||15|
|Journal||Today's Therapeutic Trends|
|State||Published - Jan 1 2000|
ASJC Scopus subject areas