title: Antithrombotics in acute coronary syndromes: actual guidelines and new evidences.
abstract: OBJECTIVE
  Acute coronary syndromes (ACS) are one of the most common causes of ICU admissions. New drugs have been developed for management of ACS. These drugs reduced morbidity and mortality; however their adverse effects or their incorrect use may cause excessive bleeding. The objective of this review is to present the principal peculiarities, doses, and indications of these drugs in ACS settings.
  
  
  METHODS
  Original articles were retrieved crossing the terms acute coronary syndromes and antithrombotic therapy in the MedLine database as well as search for Brazilian and international guidelines in http://sumsearch.uthscsa.edu.
  
  
  RESULTS
  In the treatment of acute coronary syndromes with non-ST-segment elevation enoxaparin was as efficient as UFH, but with a simpler management (SYNERGY and A to Z studies). In this same setting, fondaparinux was non inferior to enoxaparin and had lesser bleedings (OASIS 5), bivalirudin, combined or not with GPIIbIIIa blockers, was not inferior when compared with other heparins (ACUITY). In ST-segment elevation ACS, enoxaparin was superior to HNF in patients treated with fibrinolysis (EXTRACT TIMI 25); in OASIS 6 fondaparinux was superior to UFH in patients treated with thrombolytic therapy and not submitted to reperfusion.
  
  
  CONCLUSIONS
  The correct management and individual combination of antithrombotic drugs are mandatory for decreased mortality and of major cardiovascular events, reducing the undesirable risk of additional bleeding.
authors.affiliation: Instituto Dante Pazzanese de Cardiologia.
authors.forename: Luiz Eduardo Fonteles
authors.initials: LE
authors.lastname: Ritt
authors.affiliation: Unidade de Pós-Operatório, Instituto Dante Pazzanese de Cardiologia.
authors.forename: Uri Prync
authors.initials: UP
authors.lastname: Flato
authors.affiliation: Centro de Treinamento em Emergência, Divisão de Pesquisa, Instituto Dante Pazzanese de Cardiologia.
authors.forename: Hélio Penna
authors.initials: HP
authors.lastname: Guimarães
authors.affiliation: Divisão de Pesquisa, Instituto Dante Pazzanese de Cardiologia.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
authors.affiliation: Instituto Dante Pazzanese de Cardiologia.
authors.forename: Leopoldo Soares
authors.initials: LS
authors.lastname: Piegas