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No Ideal Drug Regimen for Acute Coronary Syndromes

Mortality and ischemia rates similar across different treatments

TUESDAY, Dec. 4 (HealthDay News) -- Patients on different regimens to treat moderate- and high-risk acute coronary syndromes have similar outcomes in terms of composite ischemia and mortality, according to research published in the Dec. 5 issue of the Journal of the American Medical Association. Deferring administration of glycoprotein IIb/IIIa inhibitors made no difference in ischemia and mortality rates for those undergoing percutaneous coronary intervention, and resulted in a significant reduction in major bleeding at 30 days.

Gregg W. Stone, M.D., of the Cardiovascular Research Foundation at Columbia University Medical Center in New York City, and colleagues conducted a trial of 13,819 patients with moderate- and high-risk acute coronary syndromes recruited from 450 institutions in 17 countries. While 4,603 patients were given heparin plus glycoprotein IIb/IIIa inhibitors, 4,604 were given bivalirudin plus glycoprotein IIb/IIIa inhibitors, and 4,612 received bivalirudin monotherapy.

In 4,605 cases, routine upstream glycoprotein IIb/IIIa was assigned, but in 4,602 cases selective glycoprotein IIb/IIIa inhibitor administration was deferred.

After one year, the rates of composite ischemia and mortality were similar across the three drug treatment groups. "There was no statistically significant difference in the rates of composite ischemia between patients receiving routine upstream administration of glycoprotein IIb/IIIa indicators versus deferring their use for patients undergoing percutaneous coronary intervention," the authors conclude.

The study authors report receiving consulting fees from various pharmaceutical companies.

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