Thromb Haemost 2017; 117(07): 1240-1248
DOI: 10.1160/TH16-12-0963
60th Anniversary
Schattauer GmbH

Antithrombotic therapy for acute coronary syndrome: Past, present and future

Dirk Sibbing
1   Department of Cardiology, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
2   DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
,
Dominick J. Angiolillo
3   Division of Cardiology at the University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
,
Kurt Huber
4   3rd Medical Department, Cardiology and Intensive Care Medicine, and Sigmund Freud University, Medical School, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Received: 24 December 2016

Accepted after major revision: 08 March 2017

Publication Date:
09 November 2017 (online)

Summary

Plaque erosions and ruptures are the histopathological hallmarks of arterial thrombus formation in the coronary arteries. The clinical condition associated with this process is usually referred to as acute coronary syndrome (ACS). Importantly, both blood platelets and the coagulation cascade are key players for initiation, amplification and perpetuation of ACS. There has been great progress in ACS treatment in recent decades, both at the technical level of (percutaneous) revascularisation and at the level of antithrombotic treatment. Numerous trials have led to significant advancements in the development of effective anticoagulant and antiplatelet drugs. The large number of randomised controlled clinical trials (RCTs) and the huge number of patients enrolled in these RCTs, with mega trials including >10,000 patients, is unique in the history of medical research and also reflects the exceptional efforts associated with these huge research activities. The crucial issue, however, with respect to optimising treatment, relates to finding the delicate balance between the reduction of thrombotic events by effective drug treatment and the induction of bleeding that is linked to the use of potent or multiple antithrombotic agents. Interestingly, there is a gap in modern days between current guideline recommendations favouring potent platelet inhibition in ACS and the utilization of the respective drugs in clinical practice. In this review, we will summarise and discuss the past, present and future antithrombotic treatment for ACS patients with a focus on the development of optimised antiplatelet treatment strategies and their utilisation in the real world.

 
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