STATE-OF-THE-ART PAPER
Antithrombotics in Acute Coronary Syndromes
Marc P. Bonaca, MD*,
Philippe Gabriel Steg, MD ,
Laurent J. Feldman, MD,
John F. Canales, MD ,
James J. Ferguson, MD, ,
Lars Wallentin, MD, PhD||,
Robert M. Califf, MD¶,
Robert A. Harrington, MD¶ and
Robert P. Giugliano, MD, SM*,*
* TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
Centre Hospitalier Bichat-Claude Bernard, Université Paris VII–Denis Diderot, Paris, France
Texas Heart Institute at St. Luke's Episcopal Hospital, Baylor College of Medicine, Houston, Texas
The University of Texas Health Science Center at Houston, Houston, Texas
|| Uppsala Clinical Research Centre at Uppsala University, Uppsala, Sweden
¶ Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
Manuscript received June 26, 2007;
revised manuscript received March 18, 2009,
accepted March 25, 2009.
* Reprint requests and correspondence: Dr. Robert P. Giugliano, SM, TIMI Study Group, 350 Longwood Avenue, 1st Floor Offices, Boston, Massachusetts 02115 (Email: rgiugliano{at}partners.org).
Antithrombotic agents are an integral component of the medical regimens and interventional strategies currently recommended to reduce thrombotic complications in patients with acute coronary syndromes (ACS). Despite great advances with these therapies, associated high risks for thrombosis and hemorrhage remain as the result of complex interactions involving patient comorbidities, drug combinations, multifaceted dosing adjustments, and the intricacies of the care environment. As such, the optimal combinations of antithrombotic therapies, their timing, and appropriate targeted subgroups remain the focus of intense research. During the last several years a number of new antithrombotic treatments have been introduced, and new data regarding established therapies have come to light. Although treatment guidelines include the most current available data, subsequent findings can be challenging to integrate. This challenge is compounded by the complexity associated with different efficacy and safety measures and the variability in study populations, presenting syndromes, physician, and patient preferences. In this work we review recent data regarding clinically available antiplatelet and anticoagulation agents used in the treatment of patients with ACS. We address issues including relative efficacy, safety, and timing of therapies with respect to conservative and invasive treatment strategies. In specific cases we will highlight remaining questions and controversies and ongoing trials, which will hopefully shed light in these areas. In addition to reviewing existing agents, we take a look forward at the most promising new antithrombotics currently in late-stage clinical development and their potential role in the context of ACS management.
Key Words: antiplatelet • antithrombotic • anticoagulant • infarction • ischemia
|
Abbreviations and Acronyms
| | ACC = American College of Cardiology | | ACS = acute coronary syndromes | | ADP = adenosine diphosphate | | AHA = American Heart Association | | CABG = coronary artery bypass grafting | | CrCl = creatine clearance | | DTI = direct thrombin inhibitor | | ESC = European Society of Cardiology | | GPI = glycoprotein IIb/IIIa inhibitor | | LMWH = low molecular weight heparin | | MI = myocardial infarction | | NSTE-ACS = non–ST-segment elevation acute coronary syndromes | | PCI = percutaneous coronary intervention | | STEMI = ST-segment elevation myocardial infarction | | UFH = unfractionated heparin |
|
Related Article
-
Inside This Issue
J. Am. Coll. Cardiol. 2009 54: A26.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
C. Patrono, F. Andreotti, H. Arnesen, L. Badimon, C. Baigent, J.-P. Collet, R. De Caterina, D. Gulba, K. Huber, S. Husted, et al.
Antiplatelet agents for the treatment and prevention of atherothrombosis
Eur. Heart J.,
December 1, 2011;
32(23):
2922 - 2932.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. W. Buchan, J. F. Peterson, C. H. Cogbill, D. K. Anderson, J. S. Ledford, M. N. White, N. B. Quigley, P. J. Jannetto, and N. A. Ledeboer
Evaluation of a Microarray-Based Genotyping Assay for the Rapid Detection of Cytochrome P450 2C19 *2 and *3 Polymorphisms From Whole Blood Using Nanoparticle Probes
Am J Clin Pathol,
October 1, 2011;
136(4):
604 - 608.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Hechler, M. Freund, G. Alame, C. Leguay, S. Gaertner, J.-P. Cazenave, M. Petitou, and C. Gachet
The Antithrombotic Activity of EP224283, a Neutralizable Dual Factor Xa Inhibitor/Glycoprotein IIbIIIa Antagonist, Exceeds That of the Coadministered Parent Compounds
J. Pharmacol. Exp. Ther.,
August 1, 2011;
338(2):
412 - 420.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Brown, B. Joshi, N. Faraday, A. Shah, D. Yuh, J. J. Rade, and C. W. Hogue
Review Article: Emergency Cardiac Surgery in Patients with Acute Coronary Syndromes: A Review of the Evidence and Perioperative Implications of Medical and Mechanical Therapeutics
Anesth. Analg.,
April 1, 2011;
112(4):
777 - 799.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Vidwan, A. Pathak, S. Sheth, J. Huang, D. M. Monroe, and G. A. Stouffer
Activation of Protease-Activated Receptors 3 and 4 Accelerates Tissue Factor-Induced Thrombin Generation on the Surface of Vascular Smooth Muscle Cells
Arterioscler Thromb Vasc Biol,
December 1, 2010;
30(12):
2587 - 2596.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. R. Sinnaeve and F. J. Van de Werf
Chapter 42 Fibrinolytic, antithrombotic, and antiplatelet drugs in acute coronary syndrome
The ESC Textbook of Acute and Intensive Cardiac Care,
December 1, 2010;
1(1):
med-9780199584314-chapter - med-9780199584314-chapter.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Ardissino, D. Lina, and F. Notarangelo
Chapter 44 Non-ST-elevation acute coronary syndromes
The ESC Textbook of Acute and Intensive Cardiac Care,
December 1, 2010;
1(1):
med-9780199584314-chapter - med-9780199584314-chapter.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. G. Steg, S. James, R. A. Harrington, D. Ardissino, R. C. Becker, C. P. Cannon, H. Emanuelsson, A. Finkelstein, S. Husted, H. Katus, et al.
Ticagrelor Versus Clopidogrel in Patients With ST-Elevation Acute Coronary Syndromes Intended for Reperfusion With Primary Percutaneous Coronary Intervention: A Platelet Inhibition and Patient Outcomes (PLATO) Trial Subgroup Analysis
Circulation,
November 23, 2010;
122(21):
2131 - 2141.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Barrabes and L. Galian
Endogenous Thrombolysis: A Hidden Player in Acute Coronary Syndromes?
J. Am. Coll. Cardiol.,
May 11, 2010;
55(19):
2116 - 2117.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. H. Kuller
Risk Estimation in 2009
Circ Cardiovasc Qual Outcomes,
January 1, 2010;
3(1):
4 - 5.
[Full Text]
[PDF]
|
|
|
|
