Anticoagulants for the treatment of acute coronary syndrome in the era of new oral agents.
Acute coronary syndromes (ACS) cause cessation of myocardial blood flow leading to coronary ischemia. The standard medical treatment includes heparin or low molecular weight heparin in the hospital, antiplatelet agents in the hospital and long term, and occasionally warfarin long term. All of these therapies are associated with bleeding complications. Furthermore, warfarin, with its narrow therapeutic window and need for frequent laboratory monitoring, poses several disadvantages. The development of novel oral factor Xa inhibitors and oral direct thrombin inhibitors may provide an alternative to warfarin. In this review, we discuss the new agents, rivaroxaban, apixaban, and dabigatran, for the potential treatment of ACS. We also review the relevant clinical trials evaluating their effects in ACS. These novel anticoagulants allow convenience of use with no requirement for laboratory monitoring and limited drug interactions, which may provide multifaceted treatment options for ACS and anticoagulation in the future.
Division of Cardiovascular Medicine, School of Medicine, University of Missouri-Columbia, USA.
Subrata
S
Kar
Deepak L
DL
Bhatt
D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use*; D000991:Antithrombins / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D000077144:Clopidogrel; D000069604:Dabigatran; D004359:Drug Therapy, Combination; D065427:Factor Xa Inhibitors; D006470:Hemorrhage / Q000209:etiology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D009025:Morpholines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011720:Pyrazoles / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D000069552:Rivaroxaban; D013876:Thiophenes / Q000627:therapeutic use; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000925:Anticoagulants; D000991:Antithrombins; D001562:Benzimidazoles; D065427:Factor Xa Inhibitors; D009025:Morpholines; D010975:Platelet Aggregation Inhibitors; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D014859:Warfarin; D006493:Heparin; D000069552:Rivaroxaban; D000077144:Clopidogrel; D000069604:Dabigatran; D013988:Ticlopidine; D001241:Aspirin