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Current Strategies to Guide the Antiplatelet Therapy in Acute Coronary Syndromes
Isabella Russo1, Carola Griffith Brookles2,3, Cristina Barale1
1Department of Clinical and Biological Sciences, University of Turin, I-10043 Turin, Italy.
Insights
This review covers new antiplatelet therapies for acute coronary syndromes (ACS), focusing on platelet function and drug efficacy. It guides clinicians on optimal treatment strategies, including alternatives for high-bleeding-risk patients.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Antiplatelet therapy is crucial for acute coronary syndromes (ACS).
- Recent advancements necessitate updated understanding of platelet biology and its clinical implications.
Purpose of the Study:
- To review novelties in antiplatelet therapy for ACS patients.
- To provide a comprehensive overview of current data, guidelines, and recommendations.
Main Methods:
- Narrative review of recent literature on antiplatelet therapy in ACS.
- Discussion of platelet biology, signaling pathways, and aggregation mechanisms.
- Evaluation of platelet function tests, aspirin, P2Y12 inhibitors, and alternative regimens.
Main Results:
- Detailed examination of aspirin and P2Y12 inhibitors' roles in ACS.
- Critical appraisal of clinical trial evidence and international guidelines.
- Exploration of alternative antiplatelet strategies for high-bleeding-risk patients.
Conclusions:
- Clinicians need to stay updated on evolving antiplatelet therapies for ACS.
- Understanding platelet physiology and function tests is key to optimizing treatment.
- Personalized therapeutic approaches, especially for high-risk individuals, are essential.
Abstract:
The role of antiplatelet therapy in patients with acute coronary syndromes is a moving target with considerable novelty in the last few years. The pathophysiological basis of the treatment depends on platelet biology and physiology, and the interplay between these aspects and clinical practice must guide the physician in determining the best therapeutic options for patients with acute coronary syndromes. In the present narrative review, we discuss the latest novelties in the antiplatelet therapy of patients with acute coronary syndromes. We start with a description of platelet biology and the role of the main platelet signal pathways involved in platelet aggregation during an acute coronary syndrome. Then, we present the latest evidence on the evaluation of platelet function, focusing on the strengths and weaknesses of each platelet's function test. We continue our review by describing the role of aspirin and P2Y12 inhibitors in the treatment of acute coronary syndromes, critically appraising the available evidence from clinical trials, and providing current international guidelines and recommendations. Finally, we describe alternative therapeutic regimens to standard dual antiplatelet therapy, in particular for patients at high bleeding risk. The aim of our review is to give a comprehensive representation of current data on antiplatelet therapy in patients with acute coronary syndromes that could be useful both for clinicians and basic science researchers to be up-to-date on this complex topic.
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