Abstract
The glycoprotein (GP) IIb/IIIa antagonists and the low-molecular weight heparins are the newest additions to the armamentarium of antiplatelet drugs for the treatment of acute coronary syndromes. They are extremely potent inhibitors of platelet aggregation and thrombin generation, respectively. There are currently three GP IIb/IIIa inhibitors (abciximab, eptifibatide, and tirofiban) and two low-molecular weight heparins (dalteparin and enoxaparin) approved for use with acute coronary syndromes. Data continue to accumulate outlining the specific roles for these drugs in the treatment of patients with acute coronary syndromes. Clinical trials in patients with acute coronary syndromes have demonstrated that the GP IIb/IIIa antagonists and low-molecular weight heparins offer significant benefit with acceptable safety profiles. Future issues that need to be addressed include refinement of indications for administration and patient selection, comparison between existing agents, evaluation of newer agents, and optimization of dosing to maximize benefit and safety in the use of these powerful new classes of drugs.
MeSH terms
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Abciximab
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Angina, Unstable / drug therapy*
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Angina, Unstable / physiopathology
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Antibodies, Monoclonal / adverse effects
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Antibodies, Monoclonal / immunology
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Antibodies, Monoclonal / therapeutic use
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Coronary Artery Bypass
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Dalteparin / therapeutic use
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Enoxaparin / therapeutic use
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Eptifibatide
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Fibrinolytic Agents / therapeutic use*
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Hemorrhage / chemically induced
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Heparin, Low-Molecular-Weight / adverse effects
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Heparin, Low-Molecular-Weight / therapeutic use*
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Humans
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Immunoglobulin Fab Fragments / adverse effects
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Immunoglobulin Fab Fragments / immunology
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Immunoglobulin Fab Fragments / therapeutic use
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Myocardial Infarction / drug therapy*
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Myocardial Infarction / physiopathology
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Nadroparin / therapeutic use
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Peptides / adverse effects
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Peptides / therapeutic use
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Platelet Aggregation Inhibitors / therapeutic use*
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Platelet Glycoprotein GPIIb-IIIa Complex / adverse effects
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Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors*
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Platelet Glycoprotein GPIIb-IIIa Complex / immunology
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Thrombocytopenia / chemically induced
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Thrombosis / chemically induced
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Thrombosis / physiopathology
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Tirofiban
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Transaminases / blood
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Tyrosine / adverse effects
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Tyrosine / analogs & derivatives
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Tyrosine / therapeutic use
Substances
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Antibodies, Monoclonal
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Enoxaparin
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Fibrinolytic Agents
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Heparin, Low-Molecular-Weight
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Immunoglobulin Fab Fragments
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Nadroparin
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Peptides
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Platelet Aggregation Inhibitors
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Platelet Glycoprotein GPIIb-IIIa Complex
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Tyrosine
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Transaminases
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Tirofiban
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Eptifibatide
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Dalteparin
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Abciximab