Antiaggregant therapy in acute coronary syndrome

Abstract

Acute coronary syndrome is a result of acute myocardial ischemia. Treatment of acute coronary syndrome is a complex process in which antiplatelet drugs have a very important role. Activation of platelets plays the key role in the development of acute coronary syndrome. Three interrelated, and at the same time complementary therapeutic strategies provide effective antiplatelet therapy: inhibition of the enzyme cyclooxygenase (COX) (the representative of drugs belonging to this group is acetylsalicylic acid (aspirin)), inhibition of ADP-mediated platelet aggregation (thienopyridines (ticlopidine and clopidogrel) are drugs which belong to this group), inhibition of glycoprotein IIb/IIIa receptor (drugs belonging to this group are: abciximab, tirofiban, integrilin, eptifibatide). The first studies with aspirin were carried out during the 70s and 80s of the previous century, when the ASA therapy was confirmed to be beneficial in terms of reduction of ischemic coronary events. High percentage of recurrent coronary events and adverse effects of aspirin implied the development of new agents. Studies have confirmed greater efficiency of combined therapy with aspirin and clopidogrel in the prevention of acute coronary syndrome and stroke. Inhibitors of glycoprotein IIb/IIIa receptor in the parenteral form are recommended during invasive procedures, as well as the triple antiaggregant therapy, whose effects are still the subject of numerous trials.