Current and Future Options for Anticoagulant Therapy in the Acute Management of ACS

Coronary Artery Disease (PG Steg, Section Editor)

Opinion statement

Anticoagulation with a parenteral (intravenous or subcutaneous) antithrombin agent is foundational to the early management of acute coronary syndrome (ACS). While indications for, the timing of, and the choice among agents (other than aspirin) that provide antiplatelet effects are all subject to discussion, the need for acute anticoagulation is beyond question. There are a number of agents that can be used for anticoagulation in ACS, depending upon the intended near-term management of the patient (medical vs interventional), the patient’s ischemic risk, and the patient’s hemorrhagic risk. It is usually appropriate for therapy to be initiated in the emergency department (ED), which in turn supports close collaboration between “upstream” providers and interventional cardiologists. Clinical trial data suggest that “switching” agents during ACS care affords no efficacy advantage and may increase bleeding risk. At least 1 potential new agent (otamixaban) that can be used in all ACS care settings is on the near-term horizon, with the drug currently in late Phase III testing.


Anticoagulation Acute coronary syndrome Heparin Fondaparinux Enoxaparin Bivalirudin Otamixaban Antithrombin 

References and Recommended Reading

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Department of Emergency Medicine, Pennsylvania HospitalUniversity of Pennsylvania Health SystemPhiladelphiaUSA

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