New antithrombotic agents in acute coronary syndromes.

PURPOSE OF REVIEW: Acute coronary syndromes still account for high mortality in many countries. Antithrombotic therapy represents a cornerstone in the therapy of acute coronary syndromes. Recent research has focussed on improving anti-ischemic potency and reducing bleeding complications as well as improving predictability of antithrombotic efficacy.

RECENT FINDINGS: New antithrombotic drugs such as the factor Xa antagonists and the direct thrombin inhibitors have been developed and evaluated in clinical trials. Fondaparinux and bivalirudin are approved for clinical use in acute coronary syndromes. They improve the risk/benefit ratio and make routine control of their antithrombotic effect unnecessary. Other agents are being developed to further improve and facilitate antithrombotic therapy in acute coronary syndromes.

SUMMARY: Antithrombotic therapy is essential in acute coronary syndrome. New drugs are being developed to enter clinical practice and improve efficacy and safety of this therapeutic strategy.