NEW ORLEANS, March 30 -- When patients are being evaluated for antithrombin therapy in association with percutaneous coronary interventions, doctors have multiple choices that make it possible to tailor therapy, said a Cleveland Clinic investigator.
These choices include heparin, low molecular weight heparin, glycoprotein IIb/IIIa inhibitors, bivalirudin, and fondaparinux said A. Michael Lincoff, M.D, who is vice chairman for cardiovascular research at the clinic.
He discussed differing management strategies for antithrombin therapy at an industry symposium, held in conjunction with the American College of Cardiology meeting here.
"Acute coronary syndrome management is complicated because we don't have one-size-fits-all antithrombotic pathway because patients and conditions are different," said Dr. Lincoff, who served as moderator at the symposium, which was sponsored by the Medicines Company.
The foundation for treatment of patients with acute coronary syndromes is aspirin and on top of that is clopidogrel (Plavix), but even with aspirin and clopidogrel, which are considered relatively simple therapies, dose titration should be carefully monitored, Dr. Lincoff said.
Beyond aspirin and clopidogrel, doctors have to determine whether they should use glycoprotein IIb/IIIa inhibitors either upfront or during the procedure. Then, he said, comes the difficult choice--heparin or low molecular weight heparin or bivalirudin or fondaparinux?
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