Acute Coronary Syndromes

Chapter

Abstract

Acute coronary syndromes (ACS) refer to a group of clinical syndromes that result in a reduction in blood flow to myocardium. ACS is a highly prevalent and an important cause for morbidity and mortality worldwide. Potent antithrombotic and anticoagulant therapy is the mainstay of treatment with or without catheter-based or pharmacologic reperfusion therapy. In this chapter, we introduce the pathogenesis and clinical risk factors for ACS. We review relevant evidence-based clinical practice guidelines for management of patients with ACS. We highlight the role of parenteral or subcutaneous anticoagulants in the care of patients with ST-segment elevation myocardial infarction (STEMI) compared to patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). We will also evaluate how anticoagulant therapy may differ based on choice of fibrinolytic compared to catheter-based reperfusion therapy. Next, we will discuss the use of oral anticoagulants including vitamin K antagonists and direct oral anticoagulants in the secondary prevention of recurrent cardiovascular events. Finally, we will discuss treatment considerations for patients receiving oral anticoagulant therapy in addition to dual antiplatelet therapy.

Keywords

Acute coronary syndromes Unstable angina Non-ST-segment elevation acute coronary syndromes ST-segment elevation myocardial infarction Percutaneous coronary intervention Fibrinolysis Anticoagulation Coronary thrombosis Atherosclerosis 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Cardiology, Department of MedicineMassachusetts General HospitalBostonUSA

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