Efficacy and safety of enoxaparin compared with unfractionated heparin in high-risk patients with non–ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention in the Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial

Abstract Objective To assess the anticoagulant therapy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in China and to offer the rationale for establishing reasonable strategies to improve the prognosis of NSTE-ACS. Methods A total of 1,502 patients with NSTE-ACS were recruited from 28 third-grade hospitals distributed in 14 provinces and cities in China from December 2009 to December 2011. The strategies for diagnosis and treatment, decided by each hospital respectively, were used for further analysis and comparison of medication, percutaneous coronary intervention (PCI), and end points for efficacy and safety assessment at 9 and 30 days following PCI. Results A lower incidence rate (P < 0.05) was noted for efficacy and safety in patients with unstable angina (UA) than those with non-ST-segment elevation myocardial infarction (NSTE-MI). The prescription rate of unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), fondaparinux, PCI, and single medication was 0.61%, 66.42%, 30.61%, 69.64%, and 70.74%, respectively. Conclusion Compared with NSTE-MI, UA is featured with better prognosis, less severity, and different outcome. However, in clinical practice, the therapies for NSTE-MI and UA show no differences, which deserves great attention. In China, the most common anticoagulant therapies for NSTE-ACS are single medication, mainly based on LMWH and PCI.

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Association of Parenteral Anticoagulation Therapy With Outcomes in Chinese Patients Undergoing Percutaneous Coronary Intervention for Non–ST-Segment Elevation Acute Coronary Syndrome

JAMA Internal Medicine ◽

10.1001/jamainternmed.2018.5953 ◽

2019 ◽

Vol 179 (2) ◽

pp. 186 ◽

Cited By ~ 5

Author(s):

Ji-Yan Chen ◽

Peng-Cheng He ◽

Yuan-Hui Liu ◽

Xue-Biao Wei ◽

Lei Jiang ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Anticoagulation Therapy ◽

Coronary Intervention ◽

Chinese Patients ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Percutaneous Coronary ◽

Elevation Acute Coronary Syndrome

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Glycoprotein IIb/IIIa Receptor Inhibitors in Percutaneous Coronary Intervention and Acute Coronary Syndrome

Annals of Pharmacotherapy ◽

10.1345/aph.1c338 ◽

2003 ◽

Vol 37 (6) ◽

pp. 860-875 ◽

Cited By ~ 8

Author(s):

Michael A Crouch ◽

Jean M Nappi ◽

Kai I Cheang

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

High Risk ◽

Coronary Intervention ◽

Data Sources ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Percutaneous Coronary

OBJECTIVE: To review the contemporary role of the glycoprotein (GYP) IIb/IIIa receptor inhibitors abciximab, eptifibatide, and tirofiban in patients undergoing percutaneous coronary intervention (PCI) and those with an acute coronary syndrome (ACS), and to provide an algorithm based on currently available evidence for specific agents. DATA SOURCES: Primary articles were identified by a MEDLINE search (1966–January 2003); references cited in these articles provided additional resources. STUDY SELECTION AND DATA EXTRACTION: All of the articles identified from data sources were considered for relevant information; this article primarily addresses large, controlled or comparative studies, and meta-analyses. DATA SYNTHESIS: The role of GYP IIb/IIIa inhibitors in patients undergoing PCI and those with ACS has progressed markedly. To date, abciximab has the most robust data in patients undergoing PCI, particularly high-risk individuals. In PCI patients with lower risk (e.g., elective stenting), eptifibatide is a reasonable first-line option. Data do not support tirofiban for routine use in patients undergoing PCI. For individuals with signs and symptoms of ACS, specifically unstable angina or non–ST-segment elevation myocardial infarction (MI), eptifibatide or tirofiban is recommended in high-risk patients when a conservative approach is used (PCI is not planned). Abciximab is not recommended in this situation. In patients with ST-segment elevation MI (STEMI), abciximab is the only GYP IIb/IIIa inhibitor evaluated in large, well-designed investigations. For medical management in combination with a fibrinolytic agent, the role of abciximab remains unclear. For patients undergoing primary PCI for the management of STEMI, the available evidence supports the use of abciximab, albeit further investigation is warranted. CONCLUSIONS: The role of GYP IIb/IIIa inhibitors in clinical cardiology continues to evolve. Choice of the agent depends on situation of use, patient-specific characteristics and risk stratification, and, in the case of ACS, chosen management strategy (medical management or intervention).

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