Glycoprotein IIb/IIIa inhibitors (e.g. abciximab, tirofiban and eptifibatide)
are potent anti-platelet agents and are effective, but costly, in
patients with unstable angina undergoing PTCA. More recent data
support a wider role for their use in the medical management of
high-risk patients with unstable angina i.e. recurrent ischaemia,
raised troponia levels, haemodynamic instability, major
arrhythmia and early post-infarction unstable angina.^2
Unfractionated heparinreduces ischaemic episodes but most trials
have not shown greater benefit from heparin and aspirin
compared with aspirin alone. However, a meta-analysis gave a
7.9% incidence of death/MI with the combination compared with
10.4% with aspirin alone.^3
Low molecular weight heparins (e.g. dalteparin, enoxaparin)are at least
as effective as heparin and are tending to replace heparin as
standard therapy.^4
Thrombolyticsare of no proven benefit and should be avoided.
RReeffeerreenncceess
- Theroux P, Fuster V. Acute coronary syndromes. Circulation1998; 9977 :
1195–206. - National Institute for Clinical Excellence. Guidance on the use of glycoprotein
IIb/IIIa inhibitors in the treatment of acute coronary syndromes.Technology
Appraisal Guidance-No. 12, September 2000. (www.nice.org.uk)
3 Oler A, Whooley MA, Oler J. Grady D. Adding heparin to aspirin
reduces the incidence of myocardial infarction and death in patients
with unstable angina. JAMA1996; 227766 : 811–15.
4 Cohen M, Demers C, Gurfinkel EP et al. A comparison of low-
molecular weight heparin with unfractionated heparin for unstable
coronary artery disease: Efficiency and Safety of Subcutaneous
Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) Study
Group. N Engl J Med; 1997; 333377 : 447–52.