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Acute coronary syndrome
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
Suraj Kumar, Gurpreet S Wander
Glycoprotein IIb/IIIa inhibitors are a class of anti-platelet drugs given intravenously, have a more limited role in the treatment of acute coronary syndromes, but when needed, they can provide rapid onset of anti-platelet activity before the patient is taken to the catheterisation laboratory or for prevention and treatment of peri-procedural thrombotic complications. Cangrelor, a short-acting intravenous P2Y12 inhibitor, can also be used adjunct to PCI for reducing the risk of peri-procedural ischaemic events in patients who have not been pre-treated with a P2Y12 or a glycoprotein IIb/IIIa inhibitor.
Emergencies
Published in Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson, Pocket Prescriber Psychiatry, 2019
Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson
Consider (consult local protocol/cardiology on-call if unsure): Glycoprotein IIb/IIIa inhibitor: Especially if not thrombolysed (CI or presentation too late) or PCI planned and still unstable. Use with caution (especially <48 h post-thrombolysis).Rescue PCI: Especially if thrombolysis given and chest pain persists for ≥90 min or non-resolving or worsening (e.g. ≤50% reduction in) ST elevation on ECG.
Medical management of the cardiac patient undergoing coronary angiography
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Sara Hungerford, Peter Ruchin, Gerard Carroll
As soon as possible after the diagnosis of acute coronary syndrome is made, 300 mg of uncoated aspirin should be administered. Once the reperfusion strategy of PCI is confirmed, a P2Y12 receptor blocker, such as ticagrelor, clopidogrel or prasugrel, should be administered in a loading dose.34–37 For most ST-elevation myocardial infarction patients, a glycoprotein IIb/IIIa inhibitor is no longer routinely administered, but may be used in the cardiac catheterisation laboratory for evidence of no or slow reperfusion or thrombus or for clinical instability related to worsening ischemia.48–53 The following day the patient is commenced on aspirin 100 mg daily indefinitely, as well as ticagrelor, clopidogrel or prasugrel for 12 months. This corresponds to the time at which the risk of thrombosis of the coronary artery stent is increased. Careful consideration to individual product information should be followed if switching from one P2Y12 receptor blocker to another in the post-procedure period.
An update on novel therapies for treating patients with arterial thrombosis
Published in Expert Review of Hematology, 2023
Udaya S Tantry, Sanchit Duhan, Eliano Navarese, Bogumil Ramotowski, Parshotam Kundan, Kevin P Bliden, Paul Gurbel
Symptom onset in the ACS setting is the result of occlusive platelet rich thrombus generation and resultant flow reduction. Efforts to block further progression of this process requires early and effective inhibition by antiplatelet agents. Currently available potent oral P2Y12 receptor inhibitors require nearly 2 hours to achieve maximal platelet inhibition whereas immediate (within minutes) antiplatelet/antithrombotic effects are achieved only with intravenously administered agents (glycoprotein IIb/IIIa inhibitors and cangrelor) [15]. Currently, the symptom onset-to-balloon time in ST-elevation myocardial infarction (STEMI) in the contemporary arena remains unacceptably long. Since myocardial necrosis occurs at an exponential rate early after vessel occlusion [16], efforts have been undertaken to establish potent pre-hospital therapy potentially in the hands of the patient. Delayed onset of effective antiplatelet therapy likely influences the frequency of adverse CV outcomes.
Approaches to de-escalation of antiplatelet treatment in stabilized post-myocardial infarction patients with high ischemic risk
Published in Expert Review of Cardiovascular Therapy, 2022
Placido Maria Mazzone, Dominick J. Angiolillo, Davide Capodanno
In a subgroup analysis of elderly patients from the POPULAR Genetics and POPULAR Age trials (the latter being a trial of clopidogrel versus ticagrelor in elderly patients with ACS), there was no significant difference in net clinical benefit and atherothrombotic outcomes between noncarriers of a LoF allele treated with clopidogrel and patients treated with ticagrelor; bleeding was numerically but not significantly lower with clopidogrel [48]. Conversely, a significant bleeding reduction was observed in a sub analysis of POPULAR Genetics comparing noncarriers of a LoF allele who received clopidogrel with those who received standard DAPT [49]. In another study, the addition of glycoprotein IIb/IIIa inhibitors to DAPT was associated with a reduction in the risk for thrombotic/ischemic endpoints (at a cost of an increase in mostly minor bleedings) in multivariable but not in propensity score analyses at 30 days [50]. Finally, in a cost-effectiveness analysis, the genotype-guided de-escalation strategy was associated with gains in quality adjusted life years and cost savings [51].
Systemic immune-inflammation index predicts no-reflow phenomenon after primary percutaneous coronary intervention
Published in Acta Cardiologica, 2022
Kerim Esenboğa, Alparslan Kurtul, Yakup Yunus Yamantürk, Türkan Seda Tan, Durmuş Eralp Tutar
Perioperative essential medications followed clinical guidelines [3]. The application of an angiotensin converting enzyme inhibitor or angiotensin II receptor antagonist, beta blockers and statins, and the types and doses were determined by the coronary intensive care cardiologists according to the patient’s condition. The use of glycoprotein IIb/IIIa inhibitors was planned by the operator according to the patient’s clinical condition. The use of other peri-procedural medications such as intracoronary nitroglycerine and adenosine was also left to the discretion of the operator. All echocardiographic measurements were made within 24 h after the procedures, using a GE ViVidE7 ultrasound machine (GE Healthcare, Piscataway, USA) with a 3.5-MHz transducer. Left ventricular ejection fraction (LVEF) was measured using the Simpson method according to the recommendations of the American Society of Echocardiography.