[Modern therapy in acute coronary syndrome].
Inhibition of platelet aggregation with aspirin and anticoagulation with unfractionated heparin can be considered the gold standard treatment of patients with acute coronary syndromes. Replacement of unfractionated heparins by low-molecular weight heparins seem to further improve the cardiovascular risk. Additional treatment with glycoprotein IIb/IIIa receptor blockers led to a further reduction of the clinical event rate, especially in patients undergoing coronary interventions during an acute coronary syndrome (more than 30% relative risk reduction). However, the latter substances did only lead to marginal improvements in the setting of a conservative stabilization of patients with acute coronary syndrome (7% relative risk reduction). On the contrary, the initial treatment with clopidogrel in addition to aspirin and anticoagulation led to a 20% relative risk reduction for an endpoint of death, myocardial infarction and stroke in the CURE trial. The treatment with aspirin, clopidogrel (including loading-dose) for a treatment period of 3-12 months and anticoagulation for 2 days can be considered the new standard of treatment in patients with acute coronary syndromes (unstable angina, non-ST-segment elevation, myocardial infarction). Glycoprotein IIb/IIIa receptor blockers should be used especially during coronary interventions. Antianginal treatment should include nitrates and betablockers. A treatment with statins and ACE-inhibitors should be initiated in the early course of acute coronary syndrome for plaque stabilization.
Rupprecht
Hans-Jürgen
HJ
II. Medizinische Klinik und Poliklinik der Johannes Gutenberg-Universität Mainz. rupprecht@2-med.klinik.uni-mainz.de
Blankenberg
Stefan
S
Espinola-Klein
Christine
C
Meyer
Jürgen
J
D000789:Angina, Unstable / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D004359:Drug Therapy, Combination; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015996:Survival Rate; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin