ENHANCING SAFETY AND OUTCOMES WITH THE NEWER ANTITHROMBOTIC AND ANTIPLATELET AGENTS

Novel antithrombotic and antiplatelet agents may help reduce the short-term risk of ischemic complications and the long-term risk of restenosis in patients undergoing coronary revascularization procedures. Recent clinical trials suggest that, compared with heparin, direct thrombin inhibitors (such as hirudin and hirulog) offer a predictable dose-response effect on the activated partial thromboplastin time without a concomitant increase in bleeding. Among the newer antiplatetet agents, the platelet integrin glycoprotein IIb/IIIa inhibitors (including c7E3 Fab and Integrelin) have generated the greatest interest. Clinical trial data have shown that c7E3 Fab (administered in conjunction with heparin) significantly reduces ischemic events and improves clinical outcomes. In phase II trials, Integrelin has also shown similar effects. The primary limitations have been an increase in heparin-associated breeding, which suggests that the safety profile may be enhanced by careful adjustment of the heparin dose and implementation of other patient management guidelines. The safety and efficacy data obtained in future trials should shed more light on the appropriate roles of these drugs in interventional cardiology.