[Antithrombotic treatments in acute coronary syndromes with persistent ST-segment elevation]

Pharmacological treatment is essential to limit myocardial damages of occluding thrombus feature of acute coronary syndromes with persistent ST-segment elevation. Thanks to its ease of use, it will always come first and accompany a mechanical treatment that will complement its action. Research has been very active in the last few years allowing the development of new agents, mostly oral antiplatelets and intravenous or subcutaneous antithrombins. Physicians implied in strategies of reperfusion have a responsibility to choose the most suitable combination therapy taking into account delays in care, kind of reperfusion and the patient himself. The highest level of recommendation indicative of a perfect agreement of the experts is rare in this area. Therefore, guidance is needed to help physicians. Admittedly the latest European recommendations merit of having taken positions often clear when several molecules are available in the same indication. They also underline the arrival, unexpected a few years ago, of oral treatment with rapid onset and efficacy perfectly suited to start an emergency antithrombotic treatment in acute coronary syndromes with persistent ST-segment elevation. Nevertheless, progress in terms of clinical efficacy is often modest, requiring a concomitant evaluation of each new molecule's safety, particularly the risks of bleeding.