New oral anticoagulant drugs and their role in acute coronary syndromes

Maria E. Tsoumani, John A. Goudevenos, Alexandros D. Tselepis



Despite significant advances in the management of acute coronary syndrome (ACS) and long-term antiplatelet therapy after an ACS event, patients continue to be at risk of further cardiovascular events. There is evidence that recurrent events are at least partly attributed to the persistent activation of the coagulation system after ACS. This persistent coagulation led to the addition of anticoagulants for better treatment of ACS. Clinical phase II and III trials showed that the addition of a newer anticoagulant in patients with ACS has lead to a modest reduction of MACEs but increases the clinically significant bleeding. Based on the data so far, only the use of low dose rivaroxaban (2,5 mg x 2) in addition to dual antiplatelet therapy for secondary prevention of ischemic events in patients with ACS may be an alternative treatment strategy.

Keywords: acute coronary syndrome, anticoagulants, antiplatelet therapy