Recent advances in antithrombotic therapy after acute coronary syndrome.

egory of coronary heart disease that ranges from unstable angina to ST elevation myocardial infarction (MI). Its initial evaluation relies heavily on rapid triage according to the electrocardiogram and cardiac biomarkers. The cornerstone of treatment for ST ele vation MI is rapid reperfusion, which can be achieved either by fibrinolysis or primary percutaneous coronary intervention (PCI). When available, PCI is preferred if it can be achieved within 120 minutes of first medical contact, because it has been shown to reduce death, nonfatal MI or stroke. This strategy is also preferred if the MI is associated with high-risk features such as shock or heart failure, or if contraindications to fibrinolytics are present. The need for revascularization in the management of non–ST elevation acute coronary syndrome relies on risk stratification, which is based on risk factors, clinical presentation, electrocardiogram and cardiac biomarkers. An early invasive strategy with cardiac catheterization within the first 24–48 hours is preferred for patients with an unstable clinical condition and those at high risk of a serious outcome, because this strategy has been shown to reduce the long-term rate of death or nonfatal MI. This review will focus on recent advances in antiplatelet and anticoagulant agents used in the pharmacologic treatment of acute coronary syndrome. We included only the highest level of evidence, either large randomized control trials (RCTs) or meta-analyses of RCTs (Box 1).