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.
Resumen
Reviews simultaneous inhibition of platelet activation and thrombin generation in ACS, including hirudin-derivative direct thrombin inhibitors (bivalirudin) alongside DOACs and P2Y12 inhibitors.
Por qué esto importa para la hirudoterapia
Esta revisión examinó los resultados clínicos de la inhibición de múltiples vías de coagulación en pacientes con síndrome coronario agudo (SCA), basándose en evidencia de grandes ensayos controlados aleatorizados y discutiendo anticoagulantes como la bivalirudina y el fondaparinux junto con agentes antiplaquetarios más recientes. Tiene relevancia para ASH y la hirudoterapia porque la bivalirudina—un inhibidor directo de la trombina destacado en la revisión—está estructuralmente derivada de la hirudina, el potente anticoagulante presente en la saliva de la sanguijuela medicinal, lo que ilustra cómo los compuestos del secretoma de la sanguijuela siguen informando la farmacoterapia cardiovascular moderna. El énfasis de la revisión en equilibrar la reducción del riesgo isquémico frente a las complicaciones hemorrágicas proporciona un contexto útil para comprender las ventanas terapéuticas de los anticoagulantes basados en hirudina. Sin embargo, como una revisión narrativa del manejo del SCA centrada en regímenes antitrombóticos de múltiples vías, no evalúa directamente la terapia con sanguijuelas ni el secretoma más amplio de la sanguijuela, y sus hallazgos no pueden extrapolarse a la práctica clínica de la hirudoterapia.
Citación
Clinical effects with inhibition of multiple coagulative pathways in patients admitted for acute coronary syndrome.
Cavallari I et al. · Internal and emergency medicine, 2018
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026