Please click here to obtain permission to reproduce this image.
Click on image to view larger version.
Figure 10 Older Trials of Antiplatelet and Anticoagulant Therapy in UA/NSTEMI
*Best results group.  GPIIb/IIIa with no heparin.  All trials except PRISM compared GP IIb-IIIa with UFH versus UFH. Meta-analysis of randomized trials in UA/NSTEMI that have compared ASA with placebo, the combination of UFH and ASA with ASA alone, the combination of an LMWH and ASA with ASA alone, and the combination of a platelet GP IIb/IIIa antagonist, UFH, and ASA with UFH plus ASA. The risk ratio values, 95% CIs, and probability value for each trial are shown. The timing of the end point (death or MI) varied. Results with the platelet GP IIb/IIIa antagonists are reported at the 30-d time point. Incremental gain is observed from single therapy with ASA to double therapy with ASA and UFH and to triple antithrombotic therapy with ASA, UFH, and a platelet GP IIb/IIIa antagonist. In the CAPTURE trial, nearly all patients underwent PCI after 20 to 24 h per study design. Data are taken from PURSUIT (128), PRISM-PLUS (130), Lewis et al. (365), Cairns et al. (366), Théroux et al. (367), RISC group (368), ATACS group (369), Gurfinkel et al. (370), FRISC group (371), CAPTURE (372), PARAGON (373), and PRISM (374). anta. = antagonist; ASA = aspirin; ATACS = Antithrombotic Therapy in Acute Coronary Syndromes; CAPTURE = c7E3 Fab AntiPlatelet Therapy in Unstable REfractory angina; CI = confidence interval; FRISC = FRagmin during InStability in Coronary artery disease; GP = glycoprotein; hep. = heparin; LMWH = low-molecular-weight heparin; MI = myocardial infarction; NA = not applicable; PARAGON = Platelet IIb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in a Global Organization Network; PCI = percutaneous coronary intervention; PRISM = Platelet Receptor Inhibition in ischemic Syndrome Management; PRISM-PLUS = Platelet Receptor Inhibition in ischemic Syndrome Management in Patients Limited by Unstable Signs and symptoms; PURSUIT = Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy; RISC = Research on InStability in Coronary artery disease; UA/NSTEMI = unstable angina/non--ST-elevation myocardial infarction; UFH = unfractionated heparin; VA = Veterans Affairs.
|
