[How to administer antithrombotic therapy in non-ST-elevation acute coronary syndromes: guidelines and clinical...

It is well known that the role of platelets and the coagulation cascade in the pathogenesis of acute coronary syndromes (ACS) without ST-segment elevation and the antithrombotic therapy has become the pivotal treatment in these cases. The inhibitors of platelet activity (acetylsalicylic acid, thienopyridines, glycoprotein IIb/IIIa receptor blockers) and of thrombin activation (unfractionated or low-molecular-weight heparin) have gained a growing role in the treatment of patients with ACS without ST-segment elevation. According to the European Society of Cardiology guidelines, all patients with ACS without ST-segment elevation should be treated with acetylsalicylic acid, clopidogrel and heparin, independently of their risk profile; platelet glycoprotein IIb/IIIa receptor inhibitors should be administered intravenously to high-risk patients undergoing an invasive procedure (coronary angiography and percutaneous coronary intervention or coronary surgery). This review on antithrombotic treatment will focus on their correct administration suggested by the European guidelines, and will address some peculiar features related to the individual response to each drug and to the concomitant administration in selected cases. Acetylsalicylic resistance, clopidogrel administration before coronary angiography in high-risk patients, dose adjustment in patients with renal failure or low body weight, the use of low-molecular-weight heparin in the setting of coronary percutaneous intervention, the upstream use of platelet glycoprotein IIb/IIIa receptor inhibitors and the patient's wish are also discussed.