(Circulation. 1996;94:593.)
© 1996 American Heart Association, Inc.
Articles |
International Workshop on Antithrombotic Therapy for Acute Coronary Syndromes
May 9-10, 1996, Como, Italy
Correspondence to Frans Van de Werf, MD, University Hospitals Leuven, Department of Cardiology, Herestr 49, B-3000 Leuven, Belgium.
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Introduction |
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On May 9 and 10, 1996, an international workshop on antithrombotic therapy for acute coronary syndromes was organized in Como, Italy, by the Divisione di Cardiologia of the Policlinico S. Matteo of the University of Pavia, Italy; The Cleveland Clinic Foundation of Cleveland, Ohio; and the Hemophilia and Thrombosis Centre Angelo Bianchi Bonomi of Milan, Italy. This workshop could not have come at a better time. Large multicenter trials on the use of direct antithrombins in acute coronary syndromes (GUSTO IIb and TIMI 9b) recently were completed, and the preliminary results of a series of other studies with a new class of antiplatelet agents (inhibitors of the final common pathway of platelet aggregation, the glycoprotein [GP] IIb/IIIa receptor) in patients undergoing coronary interventions had been released during the preceding months.
The rationale for the use of these new antithrombotic agents, the pivotal role of thrombin and platelets for thrombus formation on the surface of a rupturing plaque, was discussed in depth by hematologists during the first part of the meeting. The hypotheses derived from their experimental work are now well accepted by clinicians and have been designated the "thrombin" and "GPIIb/IIIa" hypotheses in acute coronary syndromes. Clinical validation of these hypotheses was the topic of the second part of the meeting.
The international multicenter trials GUSTO IIb and TIMI 9b have tested the thrombin hypothesis by comparing a direct antithrombin, hirudin, with standard heparin in studies of ±12 000 and of ±3000 patients, respectively, who had an acute coronary syndrome.