Recent research on antithrombotics. News on the treatment of patients with acute coronary syndromes.
Antithrombotic therapy is the cornerstone of management of patients with acute coronary syndromes. Its role has become increasingly important with the widespread use of percutaneous revascularization, particularly after stent implantation. In this context, use of dual antiplatelet therapy is mandatory, combining aspirin with thienopyridines, mostly clopidogrel. As well as antiplatelets, anticoagulants are also required in patients with acute myocardial infarction up to the time of percutaneous intervention and stent implantation. Following the tremendous success of clopidogrel and enoxaparin over the last decade, new antithrombotic agents have been introduced, of which fondaparinux and prasugrel are examples, with both advantages and disadvantages compared to older drugs. The last European Congress in Barcelona in 2009 was particularly rich in this area as the results of three major clinical trials were presented, all with significant implications for clinical practice: the PLATO study testing the first reversible antiplatelet drug acting via the P2Y12 platelet receptor; the CURRENT-OASIS 7 study testing higher doses of aspirin and clopidogrel; and the SEPIA-ACS1 TIMI 42 trial launching the new parenteral anticoagulant otamixaban, a factor Xa inhibitor. These three trials are briefly reviewed in the current paper, highlighting the characteristics that may lead to new recommendations and the implications for daily clinical practice.
Morais
João
J
Serviço de Cardiologia Hospital de Santo André, EPE Leiria, Portugal. joaomorais@hsaleiria.min-saude.pt
D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D035843:Biomedical Research; D000077144:Clopidogrel; D003497:Cyclic N-Oxides / Q000627:therapeutic use*; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D058919:Purinergic P2 Receptor Antagonists; D011725:Pyridines / Q000627:therapeutic use*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D003497:Cyclic N-Oxides; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D058919:Purinergic P2 Receptor Antagonists; D011725:Pyridines; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; C435830:otamixaban