Unresolved issues associated with early initiation of antiplatelet therapy in acute coronary syndromes.
Early initiation of antiplatelet therapy in addition to aspirin is critical for all patients with acute coronary syndrome (ACS) due to improved short- and long-term outcomes. Thus, evidence-based practice guidelines for ACS management recommend early and intensive initiation of antiplatelet therapy with aspirin, clopidogrel, and/or glycoprotein (GP) IIb/IIIa inhibitors. Despite the comprehensive nature of current guidelines, several important clinical issues concerning the optimal initiation of antiplatelet therapy remain. This review addresses four of these clinical issues: When should GP IIb/IIIa inhibitors be initiated? When should clopidogrel be initiated? What is the optimal clopidogrel loading dose? How should antiplatelet therapy be approached in chronically anticoagulated patients?
Alagona
Peter
P
Penn State Hershey Medical Center, Penn State Heart and Vascular Institute, 500 University Drive, Hershey, PA 17033, USA. palagona@hmc.psu.edu
D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D004305:Dose-Response Relationship, Drug; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors
D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin