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Antiplatelet and anticoagulation agents in acute coronary syndromes: what is the current status and what does the future hold?

Publication ,  Journal Article
Huber, K; Bates, ER; Valgimigli, M; Wallentin, L; Kristensen, SD; Anderson, JL; Lopez Sendon, JL; Tubaro, M; Granger, CB; Bode, C; Ohman, EM; Steg, PG
Published in: Am Heart J
November 2014

Mortality and morbidity in acute coronary syndromes (ACSs), caused principally by plaque erosion or rupture leading to thrombus formation and myocardial ischemia, have been reduced by a combination of antithrombotic agents (antiplatelet drugs and anticoagulants) and early revascularization. Aspirin is the foundation antiplatelet agent. New P2Y12 receptor inhibitors (prasugrel and ticagrelor) have clear benefits compared with clopidogrel for dual antiplatelet therapy, and cangrelor or vorapaxar, a thrombin receptor inhibitor, may be of value in specific settings. Anticoagulation uses 1 of 4 choices: bivalirudin, unfractionated heparin, enoxaparin, and fondaparinux. Moreover, some patients (such as those who have chronic atrial fibrillation) require triple therapy with aspirin, clopidogrel, plus an anticoagulant, frequently a vitamin K antagonist. New oral anticoagulants have been shown to be at least as effective as vitamin K antagonists in atrial fibrillation and led to fewer bleeding complications. Finally, the combination of aspirin, clopidogrel, and low-dose rivaroxaban has recently been approved by the European Medicines Agency (but not the Food and Drug Administration) for secondary prevention after ACS. Several strategies have been developed to balance the potential benefit of antithrombotic therapy against the risk of bleeding complications, for example, radial access in coronary angiography or restricted use of combination therapy, and others are under investigation, such as discontinuation of aspirin. This overview summarizes the current status of antithrombotic therapy in ACS and describes strategies currently explored to optimize its benefit/risk ratio.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

November 2014

Volume

168

Issue

5

Start / End Page

611 / 621

Location

United States

Related Subject Headings

  • Warfarin
  • Tyrosine
  • Tirofiban
  • Ticagrelor
  • Thiophenes
  • Recombinant Proteins
  • Receptors, Thrombin
  • Pyridines
  • Purinergic P2Y Receptor Antagonists
  • Prasugrel Hydrochloride
 

Citation

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Chicago
ICMJE
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Huber, K., Bates, E. R., Valgimigli, M., Wallentin, L., Kristensen, S. D., Anderson, J. L., … Steg, P. G. (2014). Antiplatelet and anticoagulation agents in acute coronary syndromes: what is the current status and what does the future hold? Am Heart J, 168(5), 611–621. https://doi.org/10.1016/j.ahj.2014.06.014
Huber, Kurt, Eric R. Bates, Marco Valgimigli, Lars Wallentin, Steen Dalby Kristensen, Jeffrey L. Anderson, Jose Luis Lopez Sendon, et al. “Antiplatelet and anticoagulation agents in acute coronary syndromes: what is the current status and what does the future hold?Am Heart J 168, no. 5 (November 2014): 611–21. https://doi.org/10.1016/j.ahj.2014.06.014.
Huber K, Bates ER, Valgimigli M, Wallentin L, Kristensen SD, Anderson JL, et al. Antiplatelet and anticoagulation agents in acute coronary syndromes: what is the current status and what does the future hold? Am Heart J. 2014 Nov;168(5):611–21.
Huber, Kurt, et al. “Antiplatelet and anticoagulation agents in acute coronary syndromes: what is the current status and what does the future hold?Am Heart J, vol. 168, no. 5, Nov. 2014, pp. 611–21. Pubmed, doi:10.1016/j.ahj.2014.06.014.
Huber K, Bates ER, Valgimigli M, Wallentin L, Kristensen SD, Anderson JL, Lopez Sendon JL, Tubaro M, Granger CB, Bode C, Ohman EM, Steg PG. Antiplatelet and anticoagulation agents in acute coronary syndromes: what is the current status and what does the future hold? Am Heart J. 2014 Nov;168(5):611–621.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

November 2014

Volume

168

Issue

5

Start / End Page

611 / 621

Location

United States

Related Subject Headings

  • Warfarin
  • Tyrosine
  • Tirofiban
  • Ticagrelor
  • Thiophenes
  • Recombinant Proteins
  • Receptors, Thrombin
  • Pyridines
  • Purinergic P2Y Receptor Antagonists
  • Prasugrel Hydrochloride