Clinical effects with inhibition of multiple coagulative pathways in patients admitted for acute coronary syndrome
Review published in Internal and Emergency Medicine (2018)
Abstract
Platelets and the coagulation cascade play key roles in initiation, amplification, and perpetuation of acute coronary syndromes (ACS). In the past few years, there has been great progress in ACS antithrombotic treatment with the introduction of novel anticoagulants (fondaparinux and bivalirudin), more potent P2Y12 inhibitors (prasugrel and ticagrelor) and protease-activated receptor antagonists (vorapaxar). Nonetheless, patients with ACS frequently have recurrent ischemic events despite the use of currently recommended dual antiplatelet therapy, revascularization procedures as appropriate, and other evidence-based secondary preventive measures. This is the rationale beyond intensification of antiplatelet therapy. However, the major downside of intensive antithrombotic therapy is bleeding. When treating ACS patients, clinicians should find the adequate balance between the reduction of thrombotic events by effective drug treatment and the induction of bleeding that is linked to the use of potent or multiple antithrombotic agents. Numerous antithrombotic cocktails including oral anticoagulants with or without aspirin have been tested in large clinical trials with the goal of further reduction of ischemia and bleeding risk. The aim of this review is to discuss clinical outcomes resulting from inhibition of multiple coagulative pathways in patients with ACS in light of evidence from large randomized controlled clinical trials.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Reviews simultaneous inhibition of platelet activation and thrombin generation in ACS, including hirudin-derivative direct thrombin inhibitors (bivalirudin) alongside DOACs and P2Y12 inhibitors.
Why This Matters for Hirudotherapy
This review examined clinical outcomes from inhibition of multiple coagulative pathways in patients with acute coronary syndrome (ACS), drawing on evidence from large randomized controlled trials and discussing anticoagulants including bivalirudin and fondaparinux alongside newer antiplatelet agents. It holds relevance for ASH and hirudotherapy because bivalirudin—a direct thrombin inhibitor highlighted in the review—is structurally derived from hirudin, the potent anticoagulant in medicinal leech saliva, illustrating how leech-secretome compounds continue to inform modern cardiovascular pharmacotherapy. The review's emphasis on balancing ischemic risk reduction against bleeding complications provides useful context for understanding the therapeutic windows of hirudin-based anticoagulants. However, as a narrative review of ACS management focused on multi-pathway antithrombotic regimens, it does not directly evaluate leech therapy or the broader leech secretome, and its findings cannot be extrapolated to clinical hirudotherapy practice.
Citation
Clinical effects with inhibition of multiple coagulative pathways in patients admitted for acute coronary syndrome.
Cavallari I et al. · Internal and emergency medicine, 2018
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