Clinical effects with inhibition of multiple coagulative pathways in patients admitted for acute coronary syndrome.

Publisher: Springer Country of Publication: Italy NLM ID: 101263418 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1970-9366 (Electronic) Linking ISSN: 18280447 NLM ISO Abbreviation: Intern Emerg Med Subsets: MEDLINE

Publication: Milan : Springer
Original Publication: Rome, Italy : CEPI-AIM Group, 2006-

Acute Coronary Syndrome/*drug therapy ; Anticoagulants/*pharmacokinetics ; Blood Coagulation Factors/*pharmacokinetics; Administration, Oral ; Anticoagulants/therapeutic use ; Aspirin/therapeutic use ; Blood Coagulation Factors/therapeutic use ; Fondaparinux/pharmacokinetics ; Fondaparinux/therapeutic use ; Hirudins/pharmacokinetics ; Humans ; Peptide Fragments/pharmacokinetics ; Peptide Fragments/therapeutic use ; Platelet Aggregation Inhibitors/pharmacokinetics ; Platelet Aggregation Inhibitors/therapeutic use ; Recombinant Proteins/pharmacokinetics ; Recombinant Proteins/therapeutic use

Platelets and the coagulation cascade play key roles in initiation, amplification, and perpetuation of acute coronary syndromes (ACS). In the past few years, there has been great progress in ACS antithrombotic treatment with the introduction of novel anticoagulants (fondaparinux and bivalirudin), more potent P2Y 12 inhibitors (prasugrel and ticagrelor) and protease-activated receptor antagonists (vorapaxar). Nonetheless, patients with ACS frequently have recurrent ischemic events despite the use of currently recommended dual antiplatelet therapy, revascularization procedures as appropriate, and other evidence-based secondary preventive measures. This is the rationale beyond intensification of antiplatelet therapy. However, the major downside of intensive antithrombotic therapy is bleeding. When treating ACS patients, clinicians should find the adequate balance between the reduction of thrombotic events by effective drug treatment and the induction of bleeding that is linked to the use of potent or multiple antithrombotic agents. Numerous antithrombotic cocktails including oral anticoagulants with or without aspirin have been tested in large clinical trials with the goal of further reduction of ischemia and bleeding risk. The aim of this review is to discuss clinical outcomes resulting from inhibition of multiple coagulative pathways in patients with ACS in light of evidence from large randomized controlled clinical trials.

Comment in: Intern Emerg Med. 2018 Oct;13(7):985-988. (PMID: 30242604)

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Keywords: Acute coronary syndrome; Anticoagulants; Antiplatelet therapy

0 (Anticoagulants)
0 (Blood Coagulation Factors)
0 (Hirudins)
0 (Peptide Fragments)
0 (Platelet Aggregation Inhibitors)
0 (Recombinant Proteins)
J177FOW5JL (Fondaparinux)
R16CO5Y76E (Aspirin)
TN9BEX005G (bivalirudin)

Date Created: 20180323 Date Completed: 20190521 Latest Revision: 20190521

20231215

10.1007/s11739-018-1834-x

29564693