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ACC/AHA UA/NSTEMI Guidelines: Role of GP IIb/IIIa Inhibitors

ACC/AHA UA/NSTEMI Guidelines: Role of GP IIb/IIIa Inhibitors. ACC/AHA guidelines for UA/NSTEMI: GP IIb/IIIa inhibitors. I. IIa. IIb. III.

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ACC/AHA UA/NSTEMI Guidelines: Role of GP IIb/IIIa Inhibitors

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  1. ACC/AHA UA/NSTEMI Guidelines: Role of GP IIb/IIIa Inhibitors

  2. ACC/AHA guidelines for UA/NSTEMI: GP IIb/IIIa inhibitors I IIa IIb III A platelet GP IIb/IIIa antagonist should be administered in addition to ASA and heparin to patients in whomcardiac catheterization and PCI are planned. GP IIb/IIIa antagonists may also be administered just prior to PCI. Eptifibatide or tirofiban should be administered in addition to ASA and heparin in patients with continuing ischemia, elevated troponin, or other high-risk features in whom an invasive management strategy is not planned. A platelet GP IIb/IIIa antagonist should be administered to patients already receiving heparin, ASA, and clopidogrel in whom cardiac catheterization and PCI are planned. GP IIb/IIIa antagonists may also be administered just prior to PCI. Braunwald E et al. J Am Coll Cardiol. 2002;40:1366-74.

  3. ACC/AHA UA/NSTEMI Guidelines: Management of high-risk patients • Immediate treatment (Class Ia) • ASA or clopidogrel if ASA contraindicated • LMWH or UFH • GP IIb/IIIa inhibitor • High-risk patients • Signs of ischemia at rest >20 minutes AND ST-segment depression and/or elevated cardiac biomarkers Diagnostic catheterization and revascularization within 24–48 hours (Class Ia) Adapted from Braunwald E et al. J Am Coll Cardiol. 2002;40;1366-74.

  4. Mortality risk is lower with early (<24-hour) GP IIb/IIIa inhibition Adjusted OR (95% Cl) Favorsearly GP IIb/IIIa inhibitor Favors no early GP IIb/IIIa inhibitor 6 RCTs ACS (N = 31,402) 0.91 (0.81–1.02) CRUSADE ACS (N = 49,378) 0.93 (0.83–1.05) CRUSADE Tn+ (n = 32,290) 0.88 (0.77–1.01) NRMI NSTEMI (n = 60,770) 0.88 (0.79–0.97) 0.5 1.0 2.0 Odds ratio RCT = randomized control trial Tn+ = troponin positive Boersma E et al. Lancet. 2002;359:189-98. Hoekstra JW et al. Acad Emerg Med. 2005;12:431-8.

  5. Aspirin -Blocker Heparin (UFH or LMWH) GP IIb/IIIa inhibitor (all receiving PCI/cath) Clopidogrel (all receiving PCI) Catheterization/revascularization ≤48 hours Aspirin Clopidogrel -Blocker ACE inhibitor Statin/lipid lowering Smoking cessation Cardiac rehabilitation Recommended therapies for UA/NSTEMI Acute therapies (<24h) Discharge therapies Braunwald E et al. J Am Coll Cardiol. 2002;40:1355-74.

  6. Majority of ACS patients undergo catheterization CRUSADE registry data: October 1, 2004–September 30, 2005 (n = 35,897) Cath Cath PCI PCI<48 hr CABG <48 hr *Without contraindication to catheterization CRUSADE. www.crusadeqi.com

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