thienopyridine and Syndrome

The vast majority of acute coronary syndrome (ACS) trials conducted over the past two decades support the view that women have persistently higher mortality and morbidity despite the introduction of new medical therapies and devices. Even after adjustment for older age, higher prevalence of diabetes, hypertension, heart failure, smaller vessel size, and late presentation, some studies still point to a persistent sex disadvantage. Even in contemporary practice, women continue to have longer delays in presentation and treatment. Selection bias in unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) trials allows inclusion of large numbers of women with clinically insignificant coronary disease and may mistakenly shift results toward apparent benefit of a less aggressive approach. This bias causes further difficulty in determining efficacy and safety of new antithrombotic agents such as direct thrombin inhibitors and glycoprotein IIb/IIa inhibitors across the spectrum of ACS. In trials of UA/NSTEMI, use of objective evidence of ischemia such as elevated troponin levels, would greatly assist the determination of efficacy and benefit in women. Enrollment of more women in clinical trials and timely sex-specific analysis would promote a better understanding of the role of female gender in ACS and would facilitate better care of all patients.

Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Clopidogrel; Coronary Artery Bypass; Female; Fibrinolytic Agents; Humans; Myocardial Infarction; Myocardial Revascularization; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Pyridines; Stents; Syndrome; Thrombin; Ticlopidine; Women's Health

Topics: Acute Disease; Angina, Unstable; Anticoagulants; Aspirin; Clinical Trials as Topic; Coronary Disease; Heparin, Low-Molecular-Weight; Humans; Myocardial Infarction; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Pyridines; Syndrome

Topics: Angioplasty, Balloon; Anticoagulants; Clinical Trials as Topic; Coronary Disease; Europe; Heparin; Humans; Incidence; Minimally Invasive Surgical Procedures; Platelet Glycoprotein GPIIb-IIIa Complex; Postoperative Complications; Purpura, Thrombotic Thrombocytopenic; Pyridines; Risk Factors; Severity of Illness Index; Syndrome; Thrombocytopenia; Treatment Failure; United States

Although clopidogrel and aspirin (dual therapy, DT) are used for acute coronary syndrome (ACS), sometimes treatment with warfarin (triple therapy, TT) is required.. To determine the incidence, complications, and outcomes of TT.. We analyzed Israeli surveys of ACS from 2000 to 2004.. In these surveys, 5,706 (96%) were discharged alive from hospital. Post-ACS TT and DT were 76 patients (1.3%) and 2,661 patients (46.7%), respectively. The TT group was older with more prior cardiac disease. During hospitalization, the TT patients received more intravenous anticoagulant and antithrombotic agents, and had more heart failure, arrhythmias, ischemia, and major bleeding (2.6 vs. 0.6%, p=0.03). There were no differences in adjusted 30-day and 6-month mortality between the 2 groups.. TT is feasible among ACS patients who require concomitant warfarin treatment.

Topics: Aspirin; Clopidogrel; Coronary Disease; Drug Therapy, Combination; Female; Hematologic Agents; Humans; Male; Pyridines; Risk Factors; Syndrome; Ticlopidine; Ventricular Function; Warfarin

Topics: Angina, Unstable; Cardiac Catheterization; Clinical Trials as Topic; Clopidogrel; Coronary Angiography; Data Interpretation, Statistical; Humans; Myocardial Infarction; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Pyridines; Stents; Syndrome; Ticlopidine; Time Factors