TY - JOUR
T1 - Upstream treatment of acute coronary syndrome in the ED
AU - Kirk, J. Douglas
AU - Kontos, Michael
AU - Diercks, Deborah B.
N1 - Funding Information:
Editorial assistance for this article was provided by Rina Kleege, MS. This assistance was funded by Schering Corp, a division of Merck and Co., Whitehouse Station, NJ.
PY - 2011/5
Y1 - 2011/5
N2 - Rapid risk stratification, selection of downstream management options, and institution of initial pharmacotherapy are essential to ensure that patients admitted to the emergency department with acute coronary syndromes receive optimal care. A broad range of antiplatelet and antithrombotic medications is available that permits tailoring of initial pharmacotherapy to each patient's risk status. In the urgent setting, thienopyridines (clopidogrel and prasugrel) carry limitations including response variability and increased risk for bleeding in patients requiring subsequent coronary artery bypass graft surgery. Glycoprotein IIb-IIIa receptor inhibitors, although they are highly effective in preventing ischemic events, must be used with care to reduce bleeding risk. Bivalirudin, a relatively new direct thrombin inhibitor, represents another upstream option but is costly and does not have approval for this indication. Simplified institutional management paradigms can streamline the process of selecting appropriate pharmacotherapy and aid in care delivery that will optimize patient outcomes.
AB - Rapid risk stratification, selection of downstream management options, and institution of initial pharmacotherapy are essential to ensure that patients admitted to the emergency department with acute coronary syndromes receive optimal care. A broad range of antiplatelet and antithrombotic medications is available that permits tailoring of initial pharmacotherapy to each patient's risk status. In the urgent setting, thienopyridines (clopidogrel and prasugrel) carry limitations including response variability and increased risk for bleeding in patients requiring subsequent coronary artery bypass graft surgery. Glycoprotein IIb-IIIa receptor inhibitors, although they are highly effective in preventing ischemic events, must be used with care to reduce bleeding risk. Bivalirudin, a relatively new direct thrombin inhibitor, represents another upstream option but is costly and does not have approval for this indication. Simplified institutional management paradigms can streamline the process of selecting appropriate pharmacotherapy and aid in care delivery that will optimize patient outcomes.
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U2 - 10.1016/j.ajem.2010.01.023
DO - 10.1016/j.ajem.2010.01.023
M3 - Review article
C2 - 20825856
AN - SCOPUS:79955738041
SN - 0735-6757
VL - 29
SP - 446
EP - 456
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 4
ER -