THE IMPACT OF THREE DIFFERENT GLYCOPROTEIN PLATELET RECEPTOR IIb/IIIa ANTAGONISTS ON GLYCOPROTEIN IIb/IIIa PLATELET RECEPTOR INHIBITION AND CLINICAL ENDPOINTS IN PATIENTS WITH ACUTE CORONARY SYNDROMES

Exclusion Criteria1

• a. Known or suspected pregnancy.b. Thrombolytic therapy within the 48 hours prior to enrollment.c. Angina precipitated by obvious provoking factors (e.g., arrhythmia, infection, severe anemia, or hyperthyroidism).d. History or symptoms (e.g., pain radiating to the back) suggestive of aortic dissection.e. Patients with uncontrolled severe (resulting in haemodynamic instability) cardiac arrhythmias.f. Increased bleeding risk as follows: 1) Recent (<1 month) or active bleeding disorder including a history of gastrointestinal bleeding, hematuria (>10 RBC’s per high power field (hpf)), or presence of occult blood in the stool. Any patient with a known coagulopathy, platelet disorder, or history of thrombocytopenia will also be excluded. 2) Any confirmed persistent recording of systolic blood pressure exceeding 180 mm Hg and/or diastolic blood pressure exceeding 110 mm Hg at time of enrollment. 3) Any history of hemorrhagic cerebrovascular disease or active intracranial pathologic process. Any history of cerebrovascular disease (or transient ischaemic attack) within 1 year. 4) Traumatic or prolonged cardiopulmonary resuscitation within the 2 weeks prior to study enrollment. 5) Severe trauma within 3 months prior to study enrollment. 6) Major surgical procedure or any ophthalmologic surgery within 1 month prior to study enrollment. 7) Invasive procedure (or lithotripsy) within 14 days of enrollment that would significantly increase the risk of hemorrhage (such as organ biopsy). 8) Active peptic ulcer disease within the 3 months prior to study enrollment. 9) Suspected pericarditis.10) Presence of known significant retinopathy (i.e., hemorrhages, exudates, or neovascularization).g. Patients with acute pulmonary edema (rales present over more than 50% of the lung fields) or patients with severe congestive heart failure (New York Heart Association Functional Class III or IV). Patients with cardiogenic shock will also be excluded.h. Patients with hemodynamically significant valvular heart disease, hypertrophic cardiomyopathy, restrictive cardiomyopathy, or congenital heart disease.i. Patients with clinically important systemic renal, pulmonary, hepatic, endocrine (e.g., uncontrolled diabetes or uncontrolled thyroid disease), neurological, or hematological disorders. j. Patients with clinically important abnormal laboratory findings including:1. Serum creatinine >220 mmol/L.2. Hemoglobin <11 g/dL (<110 g/L) or hematocrit <34%.3. Platelet count <150,000/mm3 (<150 X 10 9/L).3. PT > 1.3 x control4. k. Treatment with abciximab within the past 96 hours.l. Patients with heparin allergy/intolerance.m. Patients currently on warfarin therapy.n. Patients with a history of cancer not known to be disease free, with the exception of basal cell carcinoma of the skin.o. Patients with any other medical condition, which, in the investigator's opinion, makes survival for the duration of the study unlikely, or would otherwise interfere with optimal participation in the study (i.e. substance abuse) or produce a significant risk to the patient.p. Inability to give informed consent.