Antiplatelet and anticoagulant use after myocardial infarction

  title={Antiplatelet and anticoagulant use after myocardial infarction},
  author={Gregory T. Almony and Jeffrey Lefkovits and Eric J. Topol},
  journal={Clinical Cardiology},
Coronary thrombosis leading to myocardial infarction is a complex process involving the interaction of the arterial wall, the coagulation cascade, and platelets. Increased understanding of the molecular biology of thrombosis has prompted an evolution in antithrombotic therapy, from the early use of warfarin following myocardial infarction to agents targeting specific receptors or modulators in the thrombotic process. The complexity of thrombosis allows for numerous sites of pharmacologic… 
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Various antagonists of the GP IIb/IIIa receptor are currently receiving considerable attention and are being investigated for various clinical settings including angina, myocardial infarction and interventional cardiology.
Trials of glycoprotein IIb‐IIIa inhibitors in non‐st‐segment elevation acute coronary syndromes: Applicability to the practice of medicine in the united states
The subject of this supplement is the review of more recent evaluations of GP IIb‐IIIa inhibitors in the context of various treatment strategies for the management of patients with unstable angina or non‐ ST‐segment elevation myocardial infarction, collectively known as non‐ST‐se segment elevation ACS.
Pharmacologic therapies after myocardial infarction.
Update on acute coronary syndromes and implications for therapy
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    Expert opinion on investigational drugs
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The purpose of this review is to describe recent studies with novel antithrombotic agents in patients with NSTE ACS, as well as to highlight recommendations for management of patients withNSTE ACS in the recently updated American College of Cardiology (ACC)/American Heart Association (AHA) guidelines.
The low‐molecular‐weight heparin dalteparin as adjuvant therapy in acute myocardial infarction: The ASSENT PLUS study
Dalteparin could be substituted for UFH as an adjunct to rt‐PA/aspirin in the management of patients with AMI, and a clear trend toward greater TTMI 3 flow with dALTeparin compared with UFH is seen.
Platelet Aggregation Inhibition with Glycoprotein IIb–IIIa Inhibitors
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The antiplatelet effect of abciximab showed more interpatient variability, whereas the median inhibition of ex vivo platelet aggregation with the approved dosing regimen for tirofiban HCl was <80% at almost all time points during drug infusion.
Thrombolytic Therapy in Acute Myocardial Infarction Part II: 1997 Update
Reteplase is a second generation thrombolytic agent that is given in two bolus injections intravenously over 30 minutes and demonstrated slightly better and more rapid improvement in myocardial perfusion with reteplase compared to tissue plasminogen activator.
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This murine monoclonal antibody provides potent antiaggregatory action and thus may be useful in preventing thrombotic complications of coronary angioplasty, but studies of its safety and efficacy during longer infusions and with larger numbers of patients are needed.
Selective thrombin inhibitors: the next generation of anticoagulants.
Recombinant hirudin for unstable angina pectoris. A multicenter, randomized angiographic trial.
Recombinant hirudin appears to be a promising antithrombotic intervention compared with heparin for inhibition of coronary artery thrombus and large-scale comparative trials are warranted.
Monitoring of fibrin generation during thrombolytic therapy of acute myocardial infarction with recombinant tissue-type plasminogen activator.
Whether FPA can indeed be considered a useful marker of reocclusion remains to be confirmed in a larger population of patients with acute myocardial infarction and thrombolytic therapy.
Randomized trial of intravenous heparin versus recombinant hirudin for acute coronary syndromes. The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIa Investigators.
Hirudin, at a slightly higher dose than previously used in a large-scale trial (approximately 20% increase) was accompanied by a twofold risk of hemorrhagic stroke in patients receiving thrombolytic therapy and intravenous heparin in the GUSTO I trial.
Hirudin in acute myocardial infarction. Safety report from the Thrombolysis and Thrombin Inhibition in Myocardial Infarction (TIMI) 9A Trial.
The rate of major spontaneous hemorrhage for both heparin and hirudin in TIMi 9A was higher than that seen in TIMI 5, TIMI 6, and GUSTO 1 and it now appears important to monitor aPTT on a regular basis when using either antithrombin to identify those patients who require downward adjustment of the infusion.