Download Acute Coronary Syndromes in Clinical Practice PDF

ISBN-10: 1848003579

ISBN-13: 9781848003576

This functional e-book offers a accomplished evaluation of the epidemiology and scientific presentation of acute coronary syndromes (ACS). It additionally publications the reader via possibility evaluate, probability stratification, prognosis, and therapy of ACS.

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Sample text

In fact, there is evidence that intracoronary administration of a glycoprotein IIb/IIIa inhibitor may reduce adverse cardiac events [32] compared with intravenous administration. 13) [33]. 009). 6) [34]. Further study of upstream versus deferred use of eptifibatide is underway in the EARLY ACS trial. Glycoprotein IIb/IIIa inhibitor recommendation Glycoprotein IIb/IIIa inhibitors are best suited for patients with ACS who undergo percutaneous coronary intervention [4,5]; however, conservatively treated patients with diabetes may also derive benefit from their use [26].

Bivalirudin has also been studied in ST-elevation myocardial infarction. This agent compared favorably to heparin and a glycoprotein IIb/IIIa inhibitor by reducing cardiovascular death, myocardial infarction, and bleeding. This was partially offset by an increase in periprocedural stent thrombosis [15]. Direct thrombin inhibitor recommendation Bivalirudin, with the option of a glycoprotein IIb/IIIa inhibitor as a bailout, is a reasonable alternative to heparin plus routine use of a glycoprotein IIb/IIIa inhibitor for non-ST-elevation ACS [4].

Circulation 2003; 107:1840–1843. 33. ; ACUITY Investigators. Routine upstream initiation vs deferred selective use of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: the ACUITY timing trial. JAMA 2007; 297:591–602. 34. Manoukian SV, Feit F, Mehran R, et al. Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes: an analysis from the ACUITY trial. J Am Coll Cardiol 2007; 49:1362–1368. , fondaparinux). The interest behind the use of anti-thrombin agents stems from the fact that ACS patients who are only treated with anti-platelet agents are still at risk of significant ischemic events.

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