Newer antithrombotic strategies in the initial management of non-ST-Segment elevation acute coronary syndromes

OBJECTIVE: TO review the place in therapy of currently available antithromb otic agents in the non-ST-segment elevation acute coronary syndromes, that is, unstable angina and non-Q-wave myocardial infarction (MI). Recommendati ons are made based on currently available data. DATA SOURCE: English-language clinical studies, position statements, and re view articles pertaining to the management of unstable angina and non-Q-wav e MI with currently available products. STUDY SELECTION: Selection of prospective clinical studies was limited to t hose focusing on the management of the non-ST-segment elevation acute coron ary syndromes, unstable angina, and non-Q-wave MI. DATA SYNTHESIS: It has yet to be determined which combination of agents (da lteparin, enoxaparin, lepirudin, clopidogrel, ticlopidine, abciximab, eptif ibatide, tirofiban) and procedural strategies most significantly reduces mo rtality and serious events in these patients. The relevant pathophysiology, diagnostic criteria, and risk-stratifying procedures are reviewed in conte xt with information from clinical studies regarding currently available age nts for the management of non-ST-segment elevation acute coronary syndromes . CONCLUSIONS: A large number of new therapeutic classes and agents are avail able for the treatment of unstable angina and non-Q-wave MI. Although the d iagnoses of unstable angina or non-Q-wave MI identity risk, treatment decis ions are often based on the presence or absence of ST-segment elevations. L imited prospective evidence delineates the proper utilization of resources to best manage these patients. Efforts should be aimed at identifying parti cular patients who will best benefit from recently available therapies.