Antiplatelet Therapy in Acute Coronary Syndromes. Evidence Based Medicine

Background: Acute coronary syndromes (ACS) represent the final step in the chronic process of atherothrombotic coronary disease which begins early in life as thickening of intima layer and progresses to fibroatheroma and fibrocalcific lesions with vulnerable characteristics. Methods: As abrupt occlusion in the settings of ACS happens due to platelet aggregation and mobilization antiplatelet treatment has gained significant interest especially in the settings of primary percutaneous intervention and the aim of this review article is to understand the current evidence justifying the use and combination of different antiplatelet agents. Results: Beyond aspirin, several antiplatelet agents (ADP receptor inhibitors, Glycoprotein IIb/IIIa inhibitors and varopaxar) are used in combination to effectively inhibit platelet activity. However the best choice, initiation, combination and duration of antithrombotic treatment, in order to maximize the effectiveness of therapy and reduce the hazard of bleeding, depends on the clinical setting and patient specific characteristics and is an issue of intense scientific interest. Conclusion: Early and potent platelet inhibition with safety reassurance can be achieved by a combination of antiplatelet agents and is essential for the management of ACS. Therefore in this review article we focus on the current evidence regarding rational, safety and effectiveness of current antiplatelet approaches in acute coronary syndromes.