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Anticoagulation Therapy. Heparins, Factor II and Factor Xa Inhibitors

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Pharmacological Treatment of Acute Coronary Syndromes

Part of the book series: Current Cardiovascular Therapy ((CCT))

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Abstract

The use of anticoagulant therapy plays an important role particularly in the early management of patients with acute coronary syndrome (ACS) and in those undergoing percutaneous coronary interventions (PCI). These include a variety of agents available for parenteral administration which may be chosen depending on the level of ischemic and hemorrhagic risk of the patient as well as the planned early management (conservative vs. invasive). Indeed, not only the choice of therapy by also timing of administration and cessation are key determinant of short and long-term outcomes of anticoagulant therapies in the setting of ACS and PCI. Given that ACS patients persist with elevated thrombin levels following an ACS event, there also has been an emerging interest on adding oral anticoagulant therapy to standard antiplatelet regiment for long-term secondary prevention of ischemic event. The present chapter is an overview of the different options of anticoagulant therapy that are available for use in ACS and PCI patients. In particular, the basic principles of pharmacology, rationale for use, indications, contraindications, dosing considerations and side effects of currently available anticoagulant therapies are summarized and recent advances in the field provided.

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Acknowledgements

Ana Muñiz-Lozano is recipient of a training grant from the Spanish Society of Cardiology (“Beca de la Sección de Cardiopatía Isquémica para Formación e Investigación Post Residencia en el Extranjero” – Sociedad Española de Cardiología).

Disclosures

Dominick J. Angiolillo has received payment as an individual for: (a) Consulting fee or honorarium from Bristol Myers Squibb, Sanofi-Aventis, Eli Lilly, Daiichi Sankyo, The Medicines Company, AstraZeneca, Merck, Evolva, Abbott Vascular and PLx Pharma; (b) Participation in review activities from Johnson & Johnson, St. Jude, and Sunovion. Institutional payments for grants from Bristol Myers Squibb, Sanofi-Aventis, Glaxo Smith Kline, Otsuka, Eli Lilly, Daiichi Sankyo, The Medicines Company, AstraZeneca, Evolva; and has other financial relationships with Esther and King Biomedical Research Grant.

Ana Muñiz-Lozano: has no conflict of interest to report.

Fabiana Rollini: has no conflict of interest to report.

Francesco Franchi: has no conflict of interest to report.

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  1. Department of Cardiology, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA

    Ana Muñiz-Lozano MD, Fabiana Rollini MD, Francesco Franchi MD & Dominick J. Angiolillo MD, PhD

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  1. Ana Muñiz-Lozano MD
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  2. Fabiana Rollini MD
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Correspondence to Dominick J. Angiolillo MD, PhD .

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  1. Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Spain

    Pablo Avanzas

  2. Department of Cardiology, The Heart Center, Rigshospitalet University Hospital of Copenhagen,, Copenhagen, Denmark

    Peter Clemmensen

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Muñiz-Lozano, A., Rollini, F., Franchi, F., Angiolillo, D.J. (2014). Anticoagulation Therapy. Heparins, Factor II and Factor Xa Inhibitors. In: Avanzas, P., Clemmensen, P. (eds) Pharmacological Treatment of Acute Coronary Syndromes. Current Cardiovascular Therapy. Springer, London. https://doi.org/10.1007/978-1-4471-5424-2_3

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