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Current Perspectives on Antithrombotic Therapy for the Treatment of Acute Coronary Syndrome

Acute coronary syndrome (ACS) is one of the leading causes of death worldwide. Percutaneous coronary intervention (PCI) is the treatment of choice for ACS as this procedure reduces the morbidity and mortality rates of patients in clinical trials and daily practice. However, patients with a history o...

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Autores principales: Towashiraporn, Korakoth, Krittayaphong, Rungroj
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8901254/
https://www.ncbi.nlm.nih.gov/pubmed/35264877
http://dx.doi.org/10.2147/IJGM.S289295
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author Towashiraporn, Korakoth
Krittayaphong, Rungroj
author_facet Towashiraporn, Korakoth
Krittayaphong, Rungroj
author_sort Towashiraporn, Korakoth
collection PubMed
description Acute coronary syndrome (ACS) is one of the leading causes of death worldwide. Percutaneous coronary intervention (PCI) is the treatment of choice for ACS as this procedure reduces the morbidity and mortality rates of patients in clinical trials and daily practice. However, patients with a history of prior ACS who undergo PCI are still at high risk for recurrent major adverse cardiac events (MACE). Because the antithrombotic drugs reduce the rate of MACE and minimize stent-related complications such as target vessel failure or stent thrombosis, the utilization of these agents is the cornerstone treatment for secondary prevention of ACS patients after PCI. Unfortunately, using the antithrombotic agents may be associated with bleeding complications, including major or fatal bleeding. Therefore, premature discontinuation of antithrombotic regimens regarding the hemorrhagic events is sometimes inevitable and possibly leads to fatal complications such as stent thrombosis. To minimize the bleeding issues, shorten antithrombotic regimens have been proposed, which theoretically offers improved safety. Nevertheless, inappropriate withdrawal of antithrombotic drugs may increase the rate of ischemic events. On the other hand, an unnecessary prolonged antithrombotic regimen may cause avoidable bleeding. Balancing the risk of bleeding against the benefits of using antithrombotic drugs is therefore challenging especially for the patients who contain both bleeding and ischemic risks such as ACS patients who are concomitant using the anticoagulants. Currently, the treatment paradigms are shifting from the “one size fits all approach” toward the “tailored approach”. This means that the antithrombotic regimens can be adjustable individually. As a result, various clinical risk scoring systems have been established to help physicians with their decision-making. However, besides the development of these dedicated scoring tools, clinical judgment for balancing the safety versus the efficacy before deciding on the antithrombotic plan is still imperative.
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spelling pubmed-89012542022-03-08 Current Perspectives on Antithrombotic Therapy for the Treatment of Acute Coronary Syndrome Towashiraporn, Korakoth Krittayaphong, Rungroj Int J Gen Med Review Acute coronary syndrome (ACS) is one of the leading causes of death worldwide. Percutaneous coronary intervention (PCI) is the treatment of choice for ACS as this procedure reduces the morbidity and mortality rates of patients in clinical trials and daily practice. However, patients with a history of prior ACS who undergo PCI are still at high risk for recurrent major adverse cardiac events (MACE). Because the antithrombotic drugs reduce the rate of MACE and minimize stent-related complications such as target vessel failure or stent thrombosis, the utilization of these agents is the cornerstone treatment for secondary prevention of ACS patients after PCI. Unfortunately, using the antithrombotic agents may be associated with bleeding complications, including major or fatal bleeding. Therefore, premature discontinuation of antithrombotic regimens regarding the hemorrhagic events is sometimes inevitable and possibly leads to fatal complications such as stent thrombosis. To minimize the bleeding issues, shorten antithrombotic regimens have been proposed, which theoretically offers improved safety. Nevertheless, inappropriate withdrawal of antithrombotic drugs may increase the rate of ischemic events. On the other hand, an unnecessary prolonged antithrombotic regimen may cause avoidable bleeding. Balancing the risk of bleeding against the benefits of using antithrombotic drugs is therefore challenging especially for the patients who contain both bleeding and ischemic risks such as ACS patients who are concomitant using the anticoagulants. Currently, the treatment paradigms are shifting from the “one size fits all approach” toward the “tailored approach”. This means that the antithrombotic regimens can be adjustable individually. As a result, various clinical risk scoring systems have been established to help physicians with their decision-making. However, besides the development of these dedicated scoring tools, clinical judgment for balancing the safety versus the efficacy before deciding on the antithrombotic plan is still imperative. Dove 2022-03-03 /pmc/articles/PMC8901254/ /pubmed/35264877 http://dx.doi.org/10.2147/IJGM.S289295 Text en © 2022 Towashiraporn and Krittayaphong. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Review
Towashiraporn, Korakoth
Krittayaphong, Rungroj
Current Perspectives on Antithrombotic Therapy for the Treatment of Acute Coronary Syndrome
title Current Perspectives on Antithrombotic Therapy for the Treatment of Acute Coronary Syndrome
title_full Current Perspectives on Antithrombotic Therapy for the Treatment of Acute Coronary Syndrome
title_fullStr Current Perspectives on Antithrombotic Therapy for the Treatment of Acute Coronary Syndrome
title_full_unstemmed Current Perspectives on Antithrombotic Therapy for the Treatment of Acute Coronary Syndrome
title_short Current Perspectives on Antithrombotic Therapy for the Treatment of Acute Coronary Syndrome
title_sort current perspectives on antithrombotic therapy for the treatment of acute coronary syndrome
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8901254/
https://www.ncbi.nlm.nih.gov/pubmed/35264877
http://dx.doi.org/10.2147/IJGM.S289295
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