Redefining medical treatment in the management of unstable angina

In 1994, the Agency for Health Care Policy and Research sponsored the devel opment of guidelines for diagnosing and managing patients with unstable ang ina. Since their publication, several important developments have occurred. The prognostic value of biochemical assays for cardiac-specific troponins T and I have been shown in many studies. The possible role for C-reactive p rotein in determining prognosis deserves further investigation. Substantial clinical benefits have been obtained with intravenous inhibitors of the pl atelet glycoprotein (GP) IIb-IIIa receptor (abciximab, eptifibatide, tirofi ban) and with one of the low-molecular-weight heparins (enoxaparin). The th erapeutic potential of other low-molecular-weight heparins, direct thrombin inhibitors, and oral GP IIb-IIIa inhibitors remains to be clarified. On th e basis of this evidence, consideration should be given to measuring serum levels of a cardiac troponin (either T or I) and using intravenous GP IIb-I IIa inhibitors and low-molecular-weight heparin in the standard management of patients with unstable angina. Am J Med. 2000;108:41-53. (C)2000 by Exce rpta Medica, Inc.