title: Emerging antithrombotic drugs for acute coronary syndrome.
abstract: BACKGROUND
  Acute coronary syndrome (ACS) encompasses acute myocardial infarction (MI) and unstable angina. Activation of platelets and coagulation cascade plays a central role in the development of ACS. Over the past decade, there have been substantial improvements in the strategies for secondary prevention of ACS, including the development of more potent oral antiplatelet agents such as prasugrel and ticagrelor. However, therapies with even better efficacy and safety profiles and more rapid onset and offset of action would be desirable.
  
  
  METHODS
  This review discusses the advantages and disadvantages of the currently available antithrombotic agents and describes the findings from recent clinical trials of three novel agents; cangrelor (an intravenous P2Y12 receptor antagonist), vorapaxar (protease-activated receptor-1 inhibitor) and rivaroxaban (an oral factor Xa inhibitor).
  
  
  CONCLUSIONS
  Cangrelor appears more promising than clopidogrel when a very rapid onset and reversal of antiplatelet effect is needed. Vorapaxar in addition to standard oral antiplatelet therapy was effective in patients with prior MI, but was not safe in patients with a prior stroke. Low dose rivaroxaban decreased cardiovascular events and mortality in patients post-ACS compared to placebo, although bleeding was increased.
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Cardiovascular Division, Department of Medicine, Boston, MA, USA.
authors.forename: Yuichi J
authors.initials: YJ
authors.lastname: Shimada
authors.forename: Robert P
authors.initials: RP
authors.lastname: Giugliano
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D000249:Adenosine Monophosphate / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007783:Lactones / Q000494:pharmacology / Q000627:therapeutic use; D009025:Morpholines / Q000494:pharmacology / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D011725:Pyridines / Q000494:pharmacology / Q000627:therapeutic use; D000069552:Rivaroxaban; D013876:Thiophenes / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D007783:Lactones; D009025:Morpholines; D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; D013876:Thiophenes; D000249:Adenosine Monophosphate; C117446:cangrelor; D000069552:Rivaroxaban; C530299:vorapaxar