Anticoagulant agents in acute coronary syndromes

There has been substantial interest in novel antiplatelet therapies; yet, despite a growing number of studies with novel anticoagulants, there have been few comprehensive reviews summarizing the data for anticoagulants in acute coronary syndromes. Large-scale trials have demonstrated the efficacy of novel procedural anticoagulants, such as selective Factor-Xa inhibitors and direct thrombin inhibitors. Moreover, with as many as 10% of patients with non-ST-segment elevation acute coronary syndrome experiencing recurrent ischemia or death in the first 30 days, there is continued interest in oral anticoagulants. The purpose of this review is to synthesize the evidence for current anticoagulants, including heparins and more recent Factor Xa inhibitors and direct thrombin inhibitors, as well as oral anticoagulants and newer agents in later phases of clinical testing.