Update on acute coronary syndromes and implications for therapy

Our understanding of the pathophysiology of acute coronary syndromes (ACS), including acute ST elevation myocardial infarction, unstable angina and non-ST-segment elevation (NSTE) myocardial infarction, has evolved considerably over the years, with atherothrombosis playing a pivotal role. This review will discuss the recent advances/recommendations for drug therapy based on this enhanced understanding of the pathophysiology of thrombosis. More recently developed agents, such as low-molecular-weight heparins (LMWHs), glycoprotein (GP) IIb-IIIa inhibitors, direct thrombin inhibitors, Factor Xa inhibitors and thienopyridines, offer several potential advantages, either as an alternative to unfractionated heparin (i.e., LMWHs) or as an add-on therapy to aspirin and unfractionated heparin (or LMWHs; e.g., GP IIb-IIIa inhibitors, thienopyridines). The purpose of this review is to describe recent studies with novel antithrombotic agents (e.g., LMWHs, thienopyridines, GP IIb-IIIa inhibitors, bivalirudin) in patients with NSTE ACS, as well as to highlight recommendations for management of patients with NSTE ACS in the recently updated American College of Cardiology (ACC)/American Heart Association (AHA) guidelines, including the appropriate use of antithrombotic therapies.