Early use of glycoprotein IIb/IIIa-receptor inhibitors in non-ST-segment-elevation acute coronary syndromes.
The early use of glycoprotein (GP) IIb/IIIa-receptor inhibitors in patients with non-ST-segment-elevation (NSTE) acute coronary syndromes (ACSs) is discussed. Unstable angina and NSTE myocardial infarction, collectively known as NSTE ACSs, are among the leading causes of morbidity and mortality in the United States. Updated guidelines from the American College of Cardiology and the American Heart Association for the management of NSTE ACSs strongly recommend that patients with intermediate- to high-risk features (e.g., ST-segment depression, elevated cardiac markers, and recurrent ischemia) be managed with an early invasive or other aggressive strategy (diagnostic angiography within 48 hours and, if warranted, percutaneous or surgical revascularization) and immediate treatment with a GP IIb/IIIa-receptor inhibitor. In low-risk patients, either an early invasive or an early conservative strategy (diagnostic angiography only for recurrent or refractory ischemia or a positive stress test result) is appropriate. For patients managed with an early conservative approach, the guidelines recommend GP IIb/IIIa-receptor inhibitor therapy with eptifibatide or tirofiban hydrochloride, especially in high-risk patients. Abciximab should not be used in patients in whom percutaneous coronary intervention is not planned. Greater implementation of the recommendations concerning the early use of GP IIb/IIIa-receptor inhibitors may result in reduced mortality rates. A large body of clinical evidence supports the updated ACC and AHA recommendations for managing patients with NSTE ACSs.
Marsh
James D
JD
Departments of Internal Medicine and Pharmacology, Cardiology Division, Wayne State University, 421 E. Canfield Avenue, Detroit, MI 48201, USA. jmarsh@intmed.wayne.edu
D000077284:Abciximab; D000208:Acute Disease; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D000077542:Eptifibatide; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010455:Peptides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide; D000077284:Abciximab