ANTIPLATELET, ANTITHROMBOTIC, AND LYTIC THERAPY FOR UNSTABLE ANGINA, AND THE APPROPRIATE ROLE OF REVASCULARIZATION

The management of unstable angina continues to be a challenge for the clinician. Evidence is accumulating that inflammation plays an importa nt role in plaque rupture and thrombosis. Thrombolytic treatment is no t indicated in unstable angina, and in fact may even be harmful. The u se of new platelet glycoprotein IIb/IIIa receptor antagonists and dire ct thrombin inhibitors offers great potential in the management of uns table angina. Balloon angioplasty for unstable angina is associated wi th a high major complication rate, which can be reduced by the use of these novel agents. New techniques such as directional atherectomy do not appear to be safer than balloon angioplasty.