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Pharmacologic Therapy for Non ST-segment Elevation Acute Coronary Syndromes: Focus on Antithrombotic Therapy

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Abstract

Antithrombotic therapy constitutes the basis of the management of acute coronary syndromes. It combines antiplatelet and anticoagulant therapy. Antiplatelet agents should combine aspirin and agents acting through the ADP pathway such as clopidogrel; newer antiplatelet agents such as prasugrel or ticagrelor have superior anti-ischemic efficacy, compared with clopidogrel. Intravenous glycoprotein IIb/IIIa inhibitors may be used in selected patients at high risk undergoing percutaneous coronary interventions. Unfractionated heparin constitutes the reference anticoagulant treatment. Enoxaparin provides slightly better anti-ischemic efficacy. Newer agents, such as bivalirudin or fondaparinux, reduce bleeding complications, with no improvement in anti-ischemic efficacy. The combination of antiplatelet and anticoagulant agents should be chosen according to the patients’ characteristics and the management strategy of the acute coronary syndrome.

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Disclosure

Nicholas Danchin reports having received consulting or speaking fees from AstraZeneca, Eli Lilly, Novo, Sanofi-Aventis, and Servier, lecture fees from Astra-Zeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Glaxo Smith Kline, Menarini, Merck-Serono, MSD-Schering Plough, Novartis, Servier, Sanofi-Aventis, The Medicines Company, and grant support from Pfizer, Servier, and The Medicines Company.

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Authors and Affiliations

  1. Hôpital Européen Georges Pompidou, Paris, Université de Paris René Descartes, Paris, France

    Nicolas Danchin & Nadia Aïssaoui

  2. Department of Coronary Artery Disease, HEGP, 20 rue Leblanc, Paris, 75015, France

    Nicolas Danchin

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  1. Nicolas Danchin
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  2. Nadia Aïssaoui
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Correspondence to Nicolas Danchin.

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Danchin, N., Aïssaoui, N. Pharmacologic Therapy for Non ST-segment Elevation Acute Coronary Syndromes: Focus on Antithrombotic Therapy. Cardiovasc Drugs Ther 24, 325–330 (2010). https://doi.org/10.1007/s10557-010-6259-3

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