Novel oral anticoagulants in acute coronary syndrome.
Author(s): Costopoulos C(1), Niespialowska-Steuden M, Kukreja N, Gorog DA.
Affiliation(s): Author information:
(1)E&N Hertfordshire NHS Trust, UK.
Publication date & source: 2013, Int J Cardiol. , 167(6):2449-55
Coronary artery disease (CAD) is a leading cause of morbidity and mortality
worldwide with a prevalence that has now reached pandemic levels as a consequence
of the rapid modernization of the developing world. Its presentation as an acute
coronary syndrome (ACS) is a frequent reason for hospital admission and of
profound implications for personal, societal and global health. Despite
improvements in the management of ACS with anti-platelet and anticoagulant
therapy and revascularization techniques, many patients continue to suffer
recurrent ischemic events. The need to reduce future cardiovascular events has
led to the development of novel therapies to prevent coronary thrombosis,
targeting thrombin-mediated pathways. These include direct Xa inhibitors
(apixaban, rivaroxaban and darexaban), direct thrombin inhibitors (dabigatran)
and PAR 1 antagonists (vorapaxar and atopaxar). This article critically reviews
the comparative mechanisms of action, the risks and benefits, together with the
clinical evidence base for the use of these novel oral agents in the management
of ACS patients.
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