title: Antiplatelet therapy in acute coronary syndromes.
abstract: BACKGROUND
  Coronary thrombosis is a frequent cause of death and myocardial infarction most often explained by superimposition of a platelet-rich thrombus on existing coronary artery disease. Therefore, antiplatelet drugs are essential in the treatment and secondary prevention of acute coronary syndromes (ACS) and during percutaneous coronary intervention. Several novel antiplatelet drugs are now available.
  
  
  METHODS
  For several years, aspirin and clopidogrel remained the cornerstone of treatment for ACS. However, prasugrel and ticagrelor have a more consistent, faster-acting and more potent antiplatelet effect than clopidogrel, which translates into improved clinical outcomes, although at the expense of an increased bleeding risk. Importantly, some patients experience cardiovascular events despite current antiplatelet treatment, because platelet activation may occur via pathways not inhibited by these agents. Therefore, improved antiplatelet strategies are warranted.
  
  
  CONCLUSIONS
  Despite undisputable benefits of current antiplatelet strategies, a considerable number of patients continue to experience adverse thrombotic events, although clinical outcomes have been improved with new oral P2Y₁₂ antagonists. New drugs have been developed, including intravenous P2Y₁₂ antagonists and oral antagonist targeting the protease-activated receptor-1 platelet activation pathway stimulated by thrombin. This review provides an overview of current and novel antiplatelet strategies and also discusses unmet needs related to antiplatelet therapy for ACS.
authors: a 1 Aarhus University Hospital, Department of Cardiology , Aarhus, Denmark +45 78 45 20 30 ; +45 78 45 22 60 ; steendk@dadlnet.dk.
authors: Erik L
authors: EL
authors: Grove
authors: a 1 Aarhus University Hospital, Department of Cardiology , Aarhus, Denmark +45 78 45 20 30 ; +45 78 45 22 60 ; steendk@dadlnet.dk.|b 2 Regional Hospital West, Department of Internal Medicine , Herning, Denmark.
authors: Morten
authors: M
authors: Würtz
authors: c 3 University of Sheffield, Department of Cardiovascular Science , Sheffield, UK.
authors: Mark R
authors: MR
authors: Thomas
authors: a 1 Aarhus University Hospital, Department of Cardiology , Aarhus, Denmark +45 78 45 20 30 ; +45 78 45 22 60 ; steendk@dadlnet.dk.
authors: Steen Dalby
authors: SD
authors: Kristensen
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000241:Adenosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use; D058925:Receptors, Purinergic P2Y12 / Q000378:metabolism; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin
keywords: acute coronary syndromes; antiplatelet drugs; aspirin; clopidogrel; glycoprotein IIb/IIIa inhibitors; percutaneous coronary intervention; prasugrel; ticagrelor; vorapaxar