Combined antithrombotic therapy for acute coronary syndrome.
Remarkable therapeutic advances in the treatment of acute coronary syndromes (ACS) have been made with combined antithrombotic therapy. Aspirin is accepted as standard therapy in the management of ACS but has significant limitations, including intolerance, resistance, and peptic ulceration. With the intravenous platelet glycoprotein IIb/IIIa inhibitors and the new thienopyridine clopidogrel, the options for acute and chronic antiplatelet therapy have expanded. Recently, the combination of antiplatelet therapy and oral anticoagulation has gained much interest and has been shown to be effective in secondary prevention of ACS. This article summarizes important recent findings on the background of existing pathological and clinical knowledge to provide an understanding of the basis of current combined antithrombotic therapy.
Gawaz
Meinrad
M
Deutsches Herzzentrum and 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. gawaz@dhn.mhn.de
Müller
Iris
I
Besta
Felicitas
F
D000284:Administration, Oral; D000789:Angina, Unstable / Q000188:drug therapy*; D000925:Anticoagulants / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D000077144:Clopidogrel; D003328:Coronary Thrombosis / Q000503:physiopathology / Q000517:prevention & control; D004176:Dipyridamole / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D004176:Dipyridamole; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin