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Unresolved issues associated with early initiation of antiplatelet therapy in acute coronary syndromes Alagona P JrJ Invasive Cardiol 2010[Jan]; 22 (1): 40-4Early initiation of antiplatelet therapy in addition to aspirin is critical for all patients with acute coronary syndrome (ACS) due to improved short- and long-term outcomes. Thus, evidence-based practice guidelines for ACS management recommend early and intensive initiation of antiplatelet therapy with aspirin, clopidogrel, and/or glycoprotein (GP) IIb/IIIa inhibitors. Despite the comprehensive nature of current guidelines, several important clinical issues concerning the optimal initiation of antiplatelet therapy remain. This review addresses four of these clinical issues: When should GP IIb/IIIa inhibitors be initiated? When should clopidogrel be initiated? What is the optimal clopidogrel loading dose? How should antiplatelet therapy be approached in chronically anticoagulated patients?|Acute Coronary Syndrome/*drug therapy[MESH]|Aspirin/therapeutic use[MESH]|Clopidogrel[MESH]|Dose-Response Relationship, Drug[MESH]|Humans[MESH]|Platelet Aggregation Inhibitors/*therapeutic use[MESH]|Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors[MESH]|Ticlopidine/analogs & derivatives/therapeutic use[MESH]|Time Factors[MESH] |
