Fibrinolytic, antiplatelet, and anticoagulant drugs in acute coronary syndromes

2021 ◽  
pp. 494-512
Author(s):  
Sigrun Halvorsen ◽  
Giuseppe Gargiulo ◽  
Marco Valgimigli ◽  
Kurt Huber
Keyword(s):  
Acute Coronary Syndromes ◽  
Plaque Rupture ◽  
Thrombus Formation ◽  
Coronary Intervention ◽  
Fibrinolytic Therapy ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
Activation Pathways

Antithrombotic therapy is a major cornerstone in the treatment of acute coronary syndromes (ACS), as thrombus formation upon a plaque rupture or an erosion plays a pivotal role in non-ST-segment elevation as well as ST-segment elevation acute coronary syndromes. Both acute and long-term oral antiplatelet therapies, targeting specific platelet activation pathways, have demonstrated significant short- and long-term benefits. The use of anticoagulants is currently largely confined to the acute setting, except in patients with a clear indication for long-term treatment, including atrial fibrillation or the presence of intraventricular thrombi. Despite the benefit of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction, fibrinolytic therapy continues to play an important role throughout the world. In this chapter, the fibrinolytic, antiplatelet, and anticoagulant agents used in the management of acute coronary syndrome patients are discussed.

Fibrinolytic, antithrombotic, and antiplatelet drugs in acute coronary syndromes

2018 ◽  
Author(s):  
Peter Sinnaeve ◽  
Frans Van de Werf
Keyword(s):  
Acute Coronary Syndromes ◽  
Plaque Rupture ◽  
Thrombus Formation ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Long Term Treatment ◽  
Coronary Syndromes

Antithrombotic therapy is a major cornerstone in the treatment for acute coronary syndromes, as thrombus formation upon a plaque rupture or an erosion plays a pivotal role in non-ST-segment elevation as well as ST-segment elevation acute coronary syndromes. Both acute and long-term oral antiplatelet therapies, targeting specific platelet activation pathways, have demonstrated significant short- and long-term benefits. The use of anticoagulants is currently largely confined to the acute setting, except in patients with a clear indication for long-term treatment, including atrial fibrillation or the presence of intraventricular thrombi. Despite the benefit of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction, fibrinolysis continues to play an important role throughout the world as well. In this chapter, the fibrinolytic, antiplatelet, and anticoagulant agents used in the management of acute coronary syndrome patients are discussed.

Fibrinolytic, antithrombotic, and antiplatelet drugs in acute coronary syndromes

2015 ◽  
Author(s):  
Peter Sinnaeve ◽  
Frans Van de Werf
Keyword(s):  
Acute Coronary Syndromes ◽  
Plaque Rupture ◽  
Thrombus Formation ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Long Term Treatment ◽  
Coronary Syndromes

Antithrombotic therapy is a major cornerstone in the treatment for acute coronary syndromes, as thrombus formation upon a plaque rupture or an erosion plays a pivotal role in non-ST-segment elevation as well as ST-segment elevation acute coronary syndromes. Both acute and long-term oral antiplatelet therapies, targeting specific platelet activation pathways, have demonstrated significant short- and long-term benefits. The use of anticoagulants is currently largely confined to the acute setting, except in patients with a clear indication for long-term treatment, including atrial fibrillation or the presence of intraventricular thrombi. Despite the benefit of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction, fibrinolysis continues to play an important role throughout the world as well. In this chapter, the fibrinolytic, antiplatelet, and anticoagulant agents used in the management of acute coronary syndrome patients are discussed.

Percutaneous coronary interventions in acute coronary syndromes

2016 ◽  
Author(s):  
Viktor Kočka ◽  
Steen Dalby Kristensen ◽  
William Wijns ◽  
Petr Toušek ◽  
Petr Widimský
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Coronary Angiography ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Risk Criterion ◽  
Coronary Syndromes

Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following:All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hoursPatients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groupsOther patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentationLow-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testingStents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settingsTriple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk

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