Page 2409 - Hematology_ Basic Principles and Practice ( PDFDrive )

Chapter 146 Acute Coronary Syndromes 2151

Davi G, Patrono C: Platelet activation and atherothrombosis. N Engl J Med
Case 4: Triple Therapy
357:2482, 2007.
De LG, Navarese E, Marino P: Risk profile and benefits from Gp IIb-
A 55-year-old woman with a recent anterior myocardial infarction
treated who underwent primary percutaneous coronary intervention IIIa inhibitors among patients with ST-segment elevation myocardial
with implantation of a drug-eluting stent in the left anterior descending infarction treated with primary angioplasty: a meta-regression analysis of
coronary artery is found to have a left ventricular thrombus on trans- randomized trials. Eur Heart J 30:2705, 2009.
thoracic echocardiogram. She is taking aspirin and clopidogrel. She is Eikelboom JW, Quinlan DJ, Mehta SR, et al: Unfractionated and low-
started on intravenous heparin, which is overlapped with warfarin until molecular-weight heparin as adjuncts to thrombolysis in aspirin-treated
an international normalized ratio of 2 is achieved. She is discharged patients with ST-elevation acute myocardial infarction: a meta-analysis of
home on triple antithrombotic therapy with aspirin, clopidogrel, and the randomized trials. Circulation 112:3855, 2005.
warfarin.
Eikelboom JW, Weitz JI: New anticoagulants. Circulation 121:2010, 1523.
Comment Hirsh J, O’Donnell M, Eikelboom JW: Beyond unfractionated heparin and
Anticoagulation is indicated for the management of left ventricular warfarin: current and future advances. Circulation 116:552, 2007.
thrombosis, and the combination of aspirin and clopidogrel is indicated Holmes MV, Perel P, Shah T, et al: CYP2C19 genotype, clopidogrel metabo-
for the management of patients with drug-eluting stents. The combina- lism, platelet function, and cardiovascular events: a systematic review and
tion of an anticoagulant with dual antiplatelet therapy is associated with meta-analysis. JAMA 306:2704, 2011.
a 2%–3% incidence of major bleeding during the first 30 days and a Indications for fibrinolytic therapy in suspected acute myocardial infarction:
45
4%–12% incidence during the first year. Strategies that may help to collaborative overview of early mortality and major morbidity results from
minimize the risk of bleeding in patients receiving triple antithrombotic
are summarized in Table 146.7. The new oral anticoagulants, dabiga- all randomised trials of more than 1000 patients. Fibrinolytic Therapy
tran etexilate (110 or 150 mg twice a day), apixaban (2.5 or 5.0 mg Trialists’ (FTT) Collaborative Group. Lancet 343:311, 1994.
twice a day), or rivaroxaban (15 or 20 mg once daily), may offer an Kushner FG, Hand M, Smith SC, Jr, et al: 2009 focused updates: ACC/AHA
advantage if they are used instead of warfarin in patients who require guidelines for the management of patients with ST-elevation myocardial
triple antithrombotic therapy because they cause less serious bleeding infarction (updating the 2004 Guideline and 2007 Focused update) and
than warfarin in direct head-to-head comparisons. 46,47 However, all ACC/AHA/SCAI guidelines on percutaneous coronary intervention
anticoagulants, including the new oral agents, increase the risk of (updating the 2005 guideline and 2007 focused update): a report of the
bleeding when added to dual antiplatelet therapy. American College of Cardiology Foundation/American Heart Association
Task Force on Practice Guidelines. Circulation 120:2271, 2009.
Marchini JF, Manica A, Croce K: Stent thrombosis: Understanding and
and side-effects profile of antithrombotic therapies used in the managing a critical problem. Curr Treat Options Cardiovasc Med 14:91,
management of patients with ACS to optimize clinical outcomes. 2012.
Comparative effectiveness studies are urgently required to further Mega JL, Braunwald E, Wiviott SD, et al: Rivaroxaban in patients with a
define those combinations of antithrombotic drugs that will maximize recent acute coronary syndrome. N Engl J Med 366:9, 2011.
the net clinical benefit for patients with ACS by minimizing the risk Mehta SR, Bassand JP, Chrolavicius S, et al: Dose comparisons of clopidogrel
of both thrombotic and bleeding events. and aspirin in acute coronary syndromes. N Engl J Med 363:930, 2010.
Mehta SR, Eikelboom JW, Yusuf S: Risk of intracranial haemorrhage with
bolus versus infusion thrombolytic therapy: a meta-analysis. Lancet
SUGGESTED READINGS 356:449, 2000.
Patel SC, Mody A: Cerebral hemorrhagic complications of thrombolytic
Alexander JH, Lopes RD, James S, et al: Apixaban with antiplatelet therapy therapy. Prog Cardiovasc Dis 42:217, 1999.
after acute coronary syndrome. N Engl J Med 365:699, 2011. Patrono C, Garcia Rodriguez LA, Landolfi R, et al: Low-dose aspirin for the
Anderson JL, Adams CD, Antman EM, et al: 2011 ACCF/AHA focused prevention of atherothrombosis. N Engl J Med 353:2373, 2005.
update incorporated into the ACC/AHA 2007 guidelines for the man- Roe MT, Armstrong PW, Fox KA, et al: Prasugrel versus clopidogrel for acute
agement of patients with unstable angina/non-ST-elevation myocardial coronary syndromes without revascularization. N Engl J Med 367:1297,
infarction: a report of the American College of Cardiology Foundation/ 2012.
American Heart Association Task Force on Practice Guidelines. Circula- Sami S, Willerson JT: Contemporary treatment of unstable angina and
tion 12:e426, 2011. non-ST-segment-elevation myocardial infarction (part 1). Tex Heart Inst
Antithrombotic Trialists’ Collaboration: Collaborative meta-analysis of ran- J 37:141, 2010.
domised trials of antiplatelet therapy for prevention of death, myocardial Sami S, Willerson JT: Contemporary treatment of unstable angina and
infarction, and stroke in high risk patients. BMJ 324:71, 2002. non-ST-segment-elevation myocardial infarction (part 2). Tex Heart Inst
Antman EM, Anbe DT, Armstrong PW, et al: ACC/AHA guidelines for the J 37:262, 2010.
management of patients with ST-elevation myocardial infarction: a report Steg PG, Bhatt DL, Hamm CW, et al: Effect of cangrelor on periprocedural
of the American College of Cardiology/American Heart Association Task outcomes in percutaneous coronary interventions: a pooled analysis of
Force on Practice Guidelines (Committee to Revise the 1999 Guidelines patient-level data. Lancet 382:2013, 1981.
for the Management of Patients with Acute Myocardial Infarction). Wallentin L, Becker RC, Budaj A, et al: Ticagrelor versus clopidogrel in
Circulation 110:e82, 2004. patients with acute coronary syndromes. N Engl J Med 361:1045,
Aster RH, Curtis BR, Bougie DW, et al: Thrombocytopenia associated with 2009.
the use of GPIIb/IIIa inhibitors: position paper of the ISTH working White HD, Chew DP: Acute myocardial infarction. Lancet 372:570, 2008.
group on thrombocytopenia and GPIIb/IIIa inhibitors. J Thromb Haemost Wiviott SD, Braunwald E, McCabe CH, et al: Prasugrel versus clopidogrel
4:678, 2006. in patients with acute coronary syndromes. N Engl J Med 357:2007,
Boersma E, Harrington RA, Moliterno DJ, et al: Platelet glycoprotein IIb/ 2001.
IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major Yusuf S, Zhao F, Mehta SR, et al: Effects of clopidogrel in addition to aspirin
randomised clinical trials. Lancet 359:189, 2002. in patients with acute coronary syndromes without ST-segment elevation.
Chen ZM, Jiang LX, Chen YP, et al: Addition of clopidogrel to aspirin in N Engl J Med 345:494, 2001.
45,852 patients with acute myocardial infarction: randomised placebo-
controlled trial. Lancet 366:1607, 2005.
Collins R, MacMahon S, Flather M, et al: Clinical effects of anticoagulant REFERENCES
therapy in suspected acute myocardial infarction: Systematic overview of
randomised trials. BMJ 313:652, 1996. For the complete list of references, log on to www.expertconsult.com.