Antiplatelet and Antithrombin Strategies in Acute Coronary Syndrome: State-Of-The-Art Review
Refai Showkathali and Arun Natarajan
Affiliation: The Department of Cardiology, The Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex, United Kingdom SS16, NL.
Antiplatelet and antithrombotic agents significantly alter the clinical course of patients with acute coronary
syndrome (ACS) and hence form the bedrock of the management pathway of this closely related continuum of coronary
pathologies. The contemporary therapeutic armamentarium for the treatment of ACS now reflects the many technical and
pharmacological advances that took place over the last two decades. In the original 1996 American College of Cardiology/
American Heart Association (ACC/AHA) guidelines for the management of acute myocardial infarction, only one antiplatelet
agent (Aspirin) and one anticoagulant (unfractionated heparin) were recommended as class I therapies. Since
then many newer agents have been developed and approved for routine clinical use in ACS patients. Recent research has
focussed on improving efficacy on one hand and reducing bleeding complications on the other. This review focuses on the
mechanism, efficacy, safety profile and clinical trial evidence of P2 Y12 receptor antagonist antiplatelet agents, glycoprotein
IIb/IIIa receptor inhibitors (GPI), protease-activated receptor-1 (PAR-1) inhibitors, thrombin inhibitor bivalirudin and
Factor Xa inhibitors fondaparinaux and rivaroxaban.
Keywords: Acute coronary syndrome, ACS, antiplatelet agents, antithrombotic agents, bivalirudin, cangrelor, NSTEMI,
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