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Glenn N. Levine, MD; M. Nadir Ali, MD; Andrew I. Schafer, MD

Arch Intern Med. 2001;161:937-948.

The potential armamentarium of agents used in the treatment of acute coronary syndromes continues to expand, including such well-tested agents as aspirin, unfractionated heparin, and earlier-generation fibrinolytic agents, and newer agents such as low-molecular-weight heparins, direct thrombin inhibitors, thienopyridines, platelet glycoprotein IIb/IIIa receptor inhibitors, and bolus-administration fibrinolytic agents. Older and newer antithrombotic agents have undergone and continue to undergo intensive clinical investigation in patients with the clinical spectrum of acute coronary syndromes, which includes unstable angina, non–Q-wave (non–ST-segment elevation) myocardial infarction, and ST-segment elevation myocardial infarction. These studies, often conducted on an international scope and involving thousands of patients, provide data allowing practitioners to optimize the care of patients with acute coronary syndromes. In this article, studies of these established and newer agents in the treatment of patients with acute coronary syndromes are reviewed critically and summarized. Recommendations regarding use of antithrombotic agents in patients with acute coronary syndromes are then given.

From the Department of Medicine, Baylor College of Medicine (Drs Levine, Ali, and Schafer), the Section of Cardiology, Houston Veterans Administration Medical Center (Drs Levine and Ali), and Methodist Hospital (Dr Schafer), Houston, Tex. Dr Levine has received monetary compensation for speaking engagements on behalf of several pharmaceutical companies, including Cor/Key, which markets eptifibatide (Integrilin), and Aventis, which markets enoxaparin sodium (Lovenox). Dr Ali has received monetary compensation for speaking engagements on behalf of several pharmaceutical companies, including Merck & Co, Inc, which markets tirofiban hydrochloride (Aggrastat), and Aventis.

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