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.

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, 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.

scholarly journals Choice of revascularization method in acute coronary syndrome with non-ST-segment elevation

2021 ◽  
Vol 10 (2) ◽  
pp. 58-62
Author(s):  
A. B. Nishonov ◽  
R. S. Tarasov
Keyword(s):  
High Risk ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Complete Revascularization ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes

Aim. To analyze the results of various revascularization techniques in high-risk non – STsegment elevation in acute coronary syndromes performed during the first 24 hours.Methods. As a part of a single-center retrospective study, 45 cases of coronary artery bypass grafting (CABG) were examined in high-risk non – ST-segment elevation in acute coronary syndromes patients during the first 24 hours since their hospitalization for the period from 2017 to 2020. 45 cases of percutaneous coronary intervention (PCI) were selected from a similar group of patients with the help of the copy-pair method.Results. The groups were comparable according to such significant factors as age, gender, postinfarction cardiosclerosis, diabetes mellitus, and multifocal atherosclerosis. However, the severity of coronary atherosclerosis according to the Syntax score was significantly higher in the CABG group (p = 0.0004). The groups were comparable in achieving complete revascularization (p = 0.2). In 8.9% (n = 4) of patients in the PCI group, unscheduled repeated revascularization was required, and in 15.6% (n = 7) of cases stent restenosis/thrombosis was detected during the hospital period and between PCI stages, while in the CABG group, congenital malformations and dysfunction were not found. Mortality in the groups did not differ significantly (4 (8.8%) versus 2 (4.4%), p = 0.4).Conclusion. CABG provides freedom from repeated revascularizations, despite the initially more severe coronary lesion. 

Long-Term Outcome of Acute Coronary Syndromes in Patients on Chronic Oral Anticoagulants: Data from the EPICOR Study

2019 ◽  
Vol 18 (1) ◽  
pp. 92-99
Author(s):  
Janina Stepinska ◽  
Izabela Wojtkowska ◽  
Lieven Annemans ◽  
Nicolas Danchin ◽  
Stuart J. Pocock ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Bleeding Events ◽  
Long Term Outcome ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Increased Risk ◽  
Coronary Syndromes ◽  
Antithrombotic Management

Objective: To analyze characteristics, management and outcomes of patients with acute coronary syndromes (ACS) receiving chronic oral anticoagulant (OAC) therapy enrolled in the EPICOR (long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients) prospective, international, observational study of antithrombotic management patterns in ACS survivors (NCT01171404). Methods: This post-hoc analysis evaluated the association between OAC use at baseline (OACb) and time from hospital admission to percutaneous coronary intervention (PCI) (tHA-PCI), pre-PCI thrombolysis in myocardial infarction (TIMI) 3 flow, stent type, length of hospitalization, and clinical endpoints; death, non-fatal MI, and non-fatal stroke, a composite of these ± bleeding, over 2 years’ followup. Results: Of 10,568 ACS patients, 345 (3.3%) were on OACb (non-ST-segment elevation ACS [NSTEACS], n=268; ST-segment elevation MI [STEMI], n=77). OACb patients were older with more comorbidities. In NSTE-ACS OACb patients, tHA-PCI was longer (median 57.4 vs. 27.8 h; p=.008), and TIMI 3 flow rarer (26.0 vs. 33.5%; p=0.035). OACb patients had longer mean hospital stay (NSTEACS: 8.9 vs. 7.6 days; p<0.001; STEMI: 9.5 vs. 7.8 days; p=0.015), and higher rates of the composite endpoint (NSTE-ACS: 16.8 vs. 8.8%; p<0.0001; STEMI: 23.4 vs. 5.9%; p<0.0001). Bleeding events were more common with OACb (NSTE-ACS: 6.0 vs. 3.3%; p=0.01; STEMI: 6.5 vs. 2.8%; p=0.04). Conclusion: At 2-years, OACb use was associated with an increased risk of cardiovascular and bleeding events in STEMI and NSTE-ACS. NSTE-ACS patients on OACb experienced prolonged time to intervention, lower rates of TIMI 3 flow and longer hospitalization.

Sign in / Sign up

Export Citation Format

Share Document