Cargando…
Development of New Antithrombotic Regimens for Patients with Acute Coronary Syndrome
Patients with acute coronary syndrome (ACS) require long-term antithrombotic intervention to reduce the risk of further ischemic events; dual antiplatelet therapy with a P2Y(12) inhibitor and acetylsalicylic acid (ASA) is the current standard of care. However, pivotal clinical trials report that pat...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555775/ https://www.ncbi.nlm.nih.gov/pubmed/30972665 http://dx.doi.org/10.1007/s40261-019-00769-6 |
_version_ | 1783425207370776576 |
---|---|
author | George, Sudhakar Onwordi, Eunice N. C. Gamal, Amr Zaman, Azfar |
author_facet | George, Sudhakar Onwordi, Eunice N. C. Gamal, Amr Zaman, Azfar |
author_sort | George, Sudhakar |
collection | PubMed |
description | Patients with acute coronary syndrome (ACS) require long-term antithrombotic intervention to reduce the risk of further ischemic events; dual antiplatelet therapy with a P2Y(12) inhibitor and acetylsalicylic acid (ASA) is the current standard of care. However, pivotal clinical trials report that patients receiving this treatment have a residual risk of approximately 10% for further ischemic events. The development of non-vitamin K antagonist oral anticoagulants (NOACs) has renewed interest in a ‘dual pathway’ strategy, targeting both the coagulation cascade and platelet component of thrombus formation. In the phase III ATLAS ACS 2 TIMI 51 trial, a ‘triple therapy’ approach (NOAC plus dual antiplatelet therapy) showed reduced ischemic events with rivaroxaban 2.5 mg twice daily, albeit at an increased risk of bleeding. Two studies have investigated the role of NOACs in combination with a P2Y(12) inhibitor, with or without ASA, in reducing bleeding risk in patients with atrial fibrillation undergoing percutaneous coronary intervention; two further studies are underway. Although these trials will help to inform optimal treatment protocols for secondary prevention of ACS, an individualized approach to treatment will be needed, taking account of the high frequency of co-morbid conditions found in this patient population. |
format | Online Article Text |
id | pubmed-6555775 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-65557752019-06-21 Development of New Antithrombotic Regimens for Patients with Acute Coronary Syndrome George, Sudhakar Onwordi, Eunice N. C. Gamal, Amr Zaman, Azfar Clin Drug Investig Review Article Patients with acute coronary syndrome (ACS) require long-term antithrombotic intervention to reduce the risk of further ischemic events; dual antiplatelet therapy with a P2Y(12) inhibitor and acetylsalicylic acid (ASA) is the current standard of care. However, pivotal clinical trials report that patients receiving this treatment have a residual risk of approximately 10% for further ischemic events. The development of non-vitamin K antagonist oral anticoagulants (NOACs) has renewed interest in a ‘dual pathway’ strategy, targeting both the coagulation cascade and platelet component of thrombus formation. In the phase III ATLAS ACS 2 TIMI 51 trial, a ‘triple therapy’ approach (NOAC plus dual antiplatelet therapy) showed reduced ischemic events with rivaroxaban 2.5 mg twice daily, albeit at an increased risk of bleeding. Two studies have investigated the role of NOACs in combination with a P2Y(12) inhibitor, with or without ASA, in reducing bleeding risk in patients with atrial fibrillation undergoing percutaneous coronary intervention; two further studies are underway. Although these trials will help to inform optimal treatment protocols for secondary prevention of ACS, an individualized approach to treatment will be needed, taking account of the high frequency of co-morbid conditions found in this patient population. Springer International Publishing 2019-04-11 2019 /pmc/articles/PMC6555775/ /pubmed/30972665 http://dx.doi.org/10.1007/s40261-019-00769-6 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Review Article George, Sudhakar Onwordi, Eunice N. C. Gamal, Amr Zaman, Azfar Development of New Antithrombotic Regimens for Patients with Acute Coronary Syndrome |
title | Development of New Antithrombotic Regimens for Patients with Acute Coronary Syndrome |
title_full | Development of New Antithrombotic Regimens for Patients with Acute Coronary Syndrome |
title_fullStr | Development of New Antithrombotic Regimens for Patients with Acute Coronary Syndrome |
title_full_unstemmed | Development of New Antithrombotic Regimens for Patients with Acute Coronary Syndrome |
title_short | Development of New Antithrombotic Regimens for Patients with Acute Coronary Syndrome |
title_sort | development of new antithrombotic regimens for patients with acute coronary syndrome |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555775/ https://www.ncbi.nlm.nih.gov/pubmed/30972665 http://dx.doi.org/10.1007/s40261-019-00769-6 |
work_keys_str_mv | AT georgesudhakar developmentofnewantithromboticregimensforpatientswithacutecoronarysyndrome AT onwordieunicenc developmentofnewantithromboticregimensforpatientswithacutecoronarysyndrome AT gamalamr developmentofnewantithromboticregimensforpatientswithacutecoronarysyndrome AT zamanazfar developmentofnewantithromboticregimensforpatientswithacutecoronarysyndrome |