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...

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Bibliographic Details
Published in:The Journal of invasive cardiology 2010-01, Vol.22 (1), p.40-44
Main Author: Alagona, Jr, Peter
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - drug therapy
Aspirin - therapeutic use
Dose-Response Relationship, Drug
Humans
Platelet Aggregation Inhibitors - therapeutic use
Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors
Ticlopidine - analogs & derivatives
Ticlopidine - therapeutic use
Time Factors
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Summary: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?
ISSN:1557-2501