Therapy for Patients with Acute Coronary Syndromes — New Opportunities

Acute coronary syndromes, defined as myocardial infarction with ST-segment elevation, myocardial infarction without ST-segment elevation, and unstable angina, share a common pathophysiology: atherosclerotic plaque rupture, erosion, or both with superimposed intracoronary thrombosis, commonly known as atherothrombosis.1 Two large randomized trials reported in this issue of the Journal 2,3 address the evolving use of antithrombotic agents for these syndromes; a third trial has been published recently.4 Table 1 places these trials in the context of existing practice guidelines for antithrombotic agents. The oldest antithrombotic agent is unfractionated heparin. Although treatment with unfractionated heparin is generally indicated for 24 to 48 hours in myocardial . . .