Antithrombotic therapy in non-ST-segment elevation acute coronary syndromes - Recommendations of the Rio de la Plata Expert Panel

Background: Unstable angina and non-Q-wave acute myocardial infarction (AMI ) are the most frequent causes of admission to the intensive care unit. Des pite conventional therapy, the rates of nonfatal AMI and death within 30 da ys of the episode are 10% and 13%, respectively. The limitations of convent ional antithrombotic agents have stimulated research on, and clinical trial s of, new therapeutic options. This obliges clinicians to update their know ledge constantly in order to be able to choose the best treatment for this group of patients. Objective: To develop an updated set of recommendations on current antithro mbotic treatments for acute coronary syndromes not involving ST-segment ele vation. Methods: The Rio de la Plata Expert Panel met in July 1999. The work was ca rried out by three Commissions: (i) stratification of risk; (ii) antithromb otic therapy in the intensive care unit; and (iii) antithrombotic therapy i n the cardiac catheterisation laboratory. Results: The first Commission established the clinical basis for using anti thrombotic therapy, and the second and third Commissions prepared recommend ations for therapy in the intensive care and haemodynamics units, and for t he use of diagnostic coronary angiography. Conclusions: The members of the Rio de ia Plata Expert Panel hope that this document will serve as a useful guide to professional medical practice in the treatment of unstable angina and non-Q-wave coronary syndromes.