Bonaca Marc P, Steg Philippe Gabriel, Feldman Laurent J, Canales John F, Ferguson James J, Wallentin Lars, Califf Robert M, Harrington Robert A, Giugliano Robert P
TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2009 Sep 8;54(11):969-84. doi: 10.1016/j.jacc.2009.03.083.
Antithrombotic agents are an integral component of the medical regimens and interventional strategies currently recommended to reduce thrombotic complications in patients with acute coronary syndromes (ACS). Despite great advances with these therapies, associated high risks for thrombosis and hemorrhage remain as the result of complex interactions involving patient comorbidities, drug combinations, multifaceted dosing adjustments, and the intricacies of the care environment. As such, the optimal combinations of antithrombotic therapies, their timing, and appropriate targeted subgroups remain the focus of intense research. During the last several years a number of new antithrombotic treatments have been introduced, and new data regarding established therapies have come to light. Although treatment guidelines include the most current available data, subsequent findings can be challenging to integrate. This challenge is compounded by the complexity associated with different efficacy and safety measures and the variability in study populations, presenting syndromes, physician, and patient preferences. In this work we review recent data regarding clinically available antiplatelet and anticoagulation agents used in the treatment of patients with ACS. We address issues including relative efficacy, safety, and timing of therapies with respect to conservative and invasive treatment strategies. In specific cases we will highlight remaining questions and controversies and ongoing trials, which will hopefully shed light in these areas. In addition to reviewing existing agents, we take a look forward at the most promising new antithrombotics currently in late-stage clinical development and their potential role in the context of ACS management.
抗血栓药物是目前推荐用于降低急性冠脉综合征（ACS）患者血栓形成并发症的药物治疗方案和介入策略的重要组成部分。尽管这些疗法取得了巨大进展，但由于涉及患者合并症、药物联合使用、多方面的剂量调整以及护理环境的复杂性等复杂相互作用，血栓形成和出血的相关高风险仍然存在。因此，抗血栓治疗的最佳组合、其使用时机以及合适的目标亚组仍然是深入研究的重点。在过去几年中，已经引入了一些新的抗血栓治疗方法，并且关于现有疗法的新数据也已公布。尽管治疗指南纳入了最新可得的数据，但后续研究结果可能难以整合。与不同疗效和安全措施相关的复杂性以及研究人群、呈现的综合征、医生和患者偏好的变异性加剧了这一挑战。在这项工作中，我们回顾了近期关于临床上用于治疗ACS患者的抗血小板和抗凝药物的数据。我们讨论了包括保守和侵入性治疗策略中治疗的相对疗效、安全性和时机等问题。在特定情况下我们将突出仍然存在的问题和争议以及正在进行的试验，希望这些试验能在这些领域有所启发。除了回顾现有药物，我们还展望了目前处于临床后期开发阶段最有前景的新型抗血栓药物及其在ACS管理中的潜在作用。
