Current Antithrombotic Therapy in Patients with Acute Coronary Syndromes Undergoing Percutaneous Coronary
Gabriele Pesarini1, Sara Ariotti1, Flavio Ribichini1
1Division of Cardiology, Department of Medicine, University of Verona, Italy.
Insights
Acute coronary syndromes (ACS) involve thrombosis, a critical complication of atherosclerosis. Antithrombotic therapies reduce ischemic events but increase bleeding risk, necessitating careful management in ACS patients.
Area of Science:
- Cardiology
- Vascular Biology
- Pharmacology
Background:
- Acute coronary syndromes (ACS) are life-threatening due to atherosclerotic plaque rupture and subsequent thrombosis.
- Thrombosis involves platelet aggregation and coagulation pathways, crucial in ACS pathogenesis.
- Antithrombotic therapies are vital for ACS management but carry bleeding risks.
Purpose of the Study:
- To review the physiopathological mechanisms of thrombosis in ACS.
- To provide an overview of antithrombotic drugs used in ACS.
- To present European Society of Cardiology (ESC) guidelines for ACS treatment.
Main Methods:
- Literature review of physiopathology of thrombosis.
- Analysis of clinical evidence for antiplatelet and anticoagulant agents.
- Summary of ESC recommendations for ACS management.
Main Results:
- Thrombosis in ACS is driven by platelet aggregation and coagulation.
- Available antithrombotic drugs (e.g., aspirin, warfarin) reduce ischemic events.
- Increased bleeding risk is a significant adverse effect of antithrombotic therapy.
Conclusions:
- Antithrombotic therapy is essential for reducing ischemic events in ACS.
- Balancing antithrombotic efficacy with bleeding risk is critical.
- ESC guidelines provide a framework for optimal drug utilization in ACS.
Abstract:
Acute coronary syndromes (ACS) represent a life-threatening complication of the systemic atherosclerotic process, affecting the coronary circulation. Thrombosis, defined as an uncontrolled activation of the endogenous thrombogenetic reparative process, often follows atherosclerotic plaque damage and is mainly engaged by two main pathways: platelet aggregation and coagulation. Therefore, antithrombotic therapy to modulate either pathway plays an important role for the reduction of ischaemic adverse events in ACS patients. Since the advent of aspirin and warfarin, numerous antiaggregant and anticoagulant molecules have been developed to achieve this goal, but their anti-ischaemic efficacy is often obtained at the price of augmented bleedings, which are known to be strong predictors of adverse outcome. This article briefly reviews the physiopathological mechanisms of thrombosis and presents an overview of the available literature supporting the use of these major drugs, as well as the European Society of Cardiology recommendations for their utilisation in the setting of non-ST and ST-elevation myocardial infarction undergoing invasive treatment.
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