Arid
DOI10.1345/aph.1L063
2007 guideline update for unstable anginal non-ST-segment elevation myocardial infarction: Focus on antiplatelet and anticoagulant therapies
Coons, James C.; Battistone, Sarah
通讯作者Coons, James C.
来源期刊ANNALS OF PHARMACOTHERAPY
ISSN1060-0280
EISSN1542-6270
出版年2008
卷号42期号:7-8页码:989-1001
英文摘要

OBJECTIVE: To summarize key:chahges in,the 2007 American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations for pharmacologic therapy as they relate to antiplatelets and anticoagulants, and to evaluate the evidence from several landmark trials that was used to support the guideline updates for these agents.


DATA SOURCES: Literature was accessed through MEDLINE (1950-January 2008) using the search terms acute coronary syndromes, unstable angina (UA), non-ST-segment. elevation myocardial infarction (NSTEMI), antiplatelet, and anticoagulant. All papers were cross-referenced to identify additional studies.


STUDY SELECTION AND DATA EXTRACTION: ACC/AHA guidelines, relevant original research articles, and review articles were evaluated. Studies with more than 1000 patients were the focus of the


DATA SYNTHESIS: UA and NSTEMI are the most common presentations of acute coronary syndrome. The recently updated ACC/AHA guidelines for management of this condition were based on significant advances in pharmacotherapy including expanded use of drug-eluting stents, pretreatment with clopidogrel, and newer anticoagulants such as bivalirudin and,,fondaparinux. Landmark trials have been published that describe advances in the use of antiplatelets and anticoagulants. According to the guidelines, unfractionated heparin (UFH) and enoxaparin are preferred options for both invasive and ’ conservative management. Enoxaparin was noninferior to UFH for invasive management in the SYNERGY trial, although it was associated with a higher incidence of bleeding. Other alternatives for an invasive strategy per the guidelines include bivalirudin and fondaparinux. Bivalirudin (alone or with glycoprotein [GP] IIb/IIIa inhibitor) was compared with heparin plus GP IIb/IIIa inhibitor in the ACUITY trial of patients undergoing early invasive management. The bivalirudin groups were noninferior to standard of care, although bivalirudin alone was associated with less bleeding. Fondaparinux was found to be noninferior to enoxaparin and was associated with fewer bleeding events in the OASIS-5 study of patients who were not treated with an early invasive approach. Accordingly, the guidelines list fondaparinux as an alternative for a conservative strategy or in patents at increased risk of bleeding.


CONCLUSIONS: Clinicians should be familiar with the updated 2007 ACC/AHA guidelines and the clinical trial evidence that serves as the basis for these recommendations. It is paramount for institutions to outline a preferred and consistent treatment approach. These decisions should involve a review of established efficacy, bleeding risk, need for anticoagulant reversal, costs, and clinician familiarity with different treatment regimens.


英文关键词acute coronary syndromes anticoaqulants antiplatelets guidelines non-ST-segment elevation myocardial infarction unstable angina
类型Article
语种英语
国家USA
收录类别SCI-E
WOS记录号WOS:000258253000009
WOS关键词ACUTE CORONARY SYNDROMES ; GLYCOPROTEIN IIB/IIIA INHIBITORS ; UNFRACTIONATED HEPARIN ; CLOPIDOGREL ; INTERVENTION ; ASPIRIN ; ENOXAPARIN ; PRETREATMENT ; METAANALYSIS ; ABCIXIMAB
WOS类目Pharmacology & Pharmacy
WOS研究方向Pharmacology & Pharmacy
资源类型期刊论文
条目标识符http://119.78.100.177/qdio/handle/2XILL650/156430
作者单位Allegheny Gen Hosp, Dept Pharm, Pittsburgh, PA 15212 USA
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GB/T 7714
Coons, James C.,Battistone, Sarah. 2007 guideline update for unstable anginal non-ST-segment elevation myocardial infarction: Focus on antiplatelet and anticoagulant therapies[J],2008,42(7-8):989-1001.
APA Coons, James C.,&Battistone, Sarah.(2008).2007 guideline update for unstable anginal non-ST-segment elevation myocardial infarction: Focus on antiplatelet and anticoagulant therapies.ANNALS OF PHARMACOTHERAPY,42(7-8),989-1001.
MLA Coons, James C.,et al."2007 guideline update for unstable anginal non-ST-segment elevation myocardial infarction: Focus on antiplatelet and anticoagulant therapies".ANNALS OF PHARMACOTHERAPY 42.7-8(2008):989-1001.
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