title: Antiplatelet and antithrombin strategies in acute coronary syndrome: state-of-the-art review.
abstract: 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.
authors.affiliation: The Department of Cardiology, The Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex, United Kingdom SS16, NL. refais@gmail.com
authors.forename: Refai
authors.initials: R
authors.lastname: Showkathali
authors.forename: Arun
authors.initials: A
authors.lastname: Natarajan
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000991:Antithrombins / Q000627:therapeutic use*; D000075202:Contraindications; D004347:Drug Interactions; D065427:Factor Xa Inhibitors; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D054328:Proton Pump Inhibitors; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*
chemical_list: D000991:Antithrombins; D065427:Factor Xa Inhibitors; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D054328:Proton Pump Inhibitors; D058921:Purinergic P2Y Receptor Antagonists