CONTENTS
Yale University
School of Medicine
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New Haven, CT
06510 USA(203) 432-1333
Editorial
The use of glycoprotein IIb/IIIa receptor blocker therapy in acute coronary syndrome results in significant reductions in the composite endpoint of myocardial infarction and death in high-risk patients. The benefits of treatment are seen while patients are treated with the active drug and are durable up to six months after treatment. A greater benefit from treatment is seen in patients with elevated troponin.
Although direct comparisons between agents are not yet available, the upcoming TARGET trial is designed to examine this question. Ongoing trials will also further address issues related to the safety of chronic oral GPIIb-IIIa inhibitor therapy, low-dose fibrinolytic therapy plus GP IIb-IIIa inhibition, and combination low-molecular weight heparin and GP IIb-IIIa inhibitor therapy (A to Z trial).
Based on data from major clinical trials involving over 30,000 patients [1], the use of GP IIb/IIIa inhibitors has been recently endorsed by the ACC and AHA in patients experiencing an MI without ST-segment elevation who have some high-risk features and/or refractory ischemia, provided there is no major contraindication to therapy [2].
Clinical paradigms for the treatment of acute coronary syndrome are rapidly evolving. New antithrombotic therapies will undoubtedly provide exciting and greater benefit for patients with this syndrome in the future.
1. Topol EJ, Byzova TV, Plow EF. Platelet GPIIb-IIIa Blockers. Lancet 1999;353:227-31.
2. ACC/AHA Guidelines For the Management of Patients with Acute Myocardial Infarction. JACC 1999;34:890-911.
Last modified: September 27, 1999.
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