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… 

Glycoprotein IIb/IIIa receptor and its inhibition: A platelet-directed therapeutic strategy

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

  • G. Brogan
  • Biology, Medicine
    Expert opinion on investigational drugs
  • 2003
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.

Clinical pharmacology of eptifibatide.

Role of Clopidogrel in Unstable Angina and Non—ST‐Segment Elevation Myocardial Infarction: From Literature and Guidelines to Practice

Patient‐specific risk factors, the drugs' safety profiles, and costs, in addition to the ACC‐AHA guidelines, must all be considered by clinicians when selecting the appropriate agent and its duration of use.

Bench to bedside: pathophysiology of acute coronary syndromes and implications for therapy.

  • G. Brogan
  • Biology, Medicine
    Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
  • 2002
The molecular interactions in coronary thrombosis that may serve as therapeutic targets for more effective management of these syndromes are discussed.

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

  • G. Proimos
  • Biology
    Journal of Thrombosis and Thrombolysis
  • 2004
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.



Aspirin as an antiplatelet drug.

  • C. Patrono
  • Medicine, Biology
    The New England journal of medicine
  • 1994
A rational basis for antithrombotic prophylaxis and treatment with aspirin is described and basic information on the molecular mechanism of action of aspirin in inhibiting platelet function will be integrated with the appropriate clinical pharmacologic data and the results of randomized clinical trials.

Safety and antiplatelet effect of murine monoclonal antibody 7E3 Fab directed against platelet glycoprotein llb/llla in patients undergoing elective coronary angioplasty

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.

Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty.

Ischemic complications of coronary angioplasty and atherectomy were reduced with a monoclonal antibody directed against the platelet IIb/IIIa glycoprotein receptor, although the risk of bleeding was increased.

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.