Issues in antiplatelet therapy for UA/NSTEMI

Options for antiplatelet therapy have increased in the last decade, with th ienopyridines and GP IIb/IIIa receptor antagonists joining aspirin on the r oster of available antiplatelet agents. Both North American (ACC/AHA) and E uropean (ESC) cardiology societies have made recommendations regarding the use of antiplatelet agents in recently issued practice guidelines for the m anagement of acute coronary syndromes without ST-segment elevation. In Sept ember 2000, a group of international cardiologists meeting under the auspic es of the International Cardiology Forum participated in a workshop to exam ine the new antiplatelet recommendations. Workshop participants generally a greed that both sets of guidelines were satisfactory, however there were ar eas of disagreement. The most controversial topic was the role or GP IIb/II Ia antagonists. Given the evidence for efficacy of these agents for medical management, many participants felt that their use was overemphasized. Ther e was strong support for the use of GP IIb/IIIa inhibitors in the setting o r intervention, although cost is prohibitive in many Countries. In view of real-world limitations, guidelines for alternative management strategies ar e needed. (C) 2001 The European Society of Cardiology.