Author + information
In a recent study published in the Journal(1)Peterson et al. found that with regard to use of glycoprotein (GP) IIb/IIIa inhibitors there was a low adherence to American College of Cardiology/American Heart Association guidelines (published in 2000) for treatment of non–ST-elevation myocardial infarction (2), and they noted that increased use of this type of medication represents a target for quality improvement. The observation that most clinicians were not implanting recommendations from published guidelines is important, but conclusions regarding specific use of GP IIb/IIIa inhibitors are limited by the fact that the guidelines referenced in this study have already been superseded by new guidelines published in 2002 (3), which incorporate research showing the importance of adding clopidogrel to aspirin early in the treatment of acute coronary syndromes (4).
The role of GP IIb/IIIa inhibitors for treatment of acute coronary syndromes at this time is not clear. Therapy with clopidogrel has not been compared directly to therapy with GP IIb/IIIa inhibitors, and further data need to be obtained to determine the incremental value for adding GP IIb/IIIa inhibitors to aspirin/clopidogrel/heparin therapy (5). Recommendations may differ in patients with different prognostic risk (as assessed by clinical/laboratory variables at time of initial presentation) and whether an interventional or noninterventional approach is being used. In many cases, GP IIb/IIIa inhibitors may be a fourth element of antiplatelet/antithrombotic therapy to consider in patients with acute coronary syndromes.
- American College of Cardiology Foundation
- Peterson E.D.,
- Pollack C.V.,
- Roe M.T.,
- et al.
- Braunwald E.,
- Antman E.M.,
- Beasley J.W.,
- et al.
- The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators
- ↵Harding SA, Boon NA, Flapan AD. Antiplatelet treatment in unstable angina: aspirin, clopidogrel, glycoprotein IIb/IIIa antagonist, or all three? Heart 2002;88:11–14