Antiplatelet therapy in acute coronary syndromes: current agents and impact on patient outcomes

Abstract

Platelets play a central role in atherothrombosis and subsequent development of acute coronary syndromes (ACS). The understanding of this process has driven a large body of evidence demonstrating the mortality and morbidity benefits of antiplatelet agents in the ACS population. As expected, however, these agents come with an intrinsically increased risk of bleeding which underlies the vast majority of their complications and adverse effects. In today’s setting of compounding comorbidities and broadening indications, finding the balance between thrombosis prevention and bleeding risk remains the challenge for all clinicians considering these medications. This article reviews the current main antiplatelet agents that are available for clinical use and outlines their impact on ACS outcome. We also outline factors which affect the response to these agents and discuss strategies to optimize clinical outcomes.

Early or First Aid Administration Versus Late or In-hospital Administration of Aspirin for Non-traumatic Adult Chest Pain: A Systematic Review

“…This systematic review searched for the benefits associated with the early or first aid administration as compared with late or in-hospital administration of aspirin to adults with non-traumatic chest pain. The hypothesis behind comparing early with late administration is that the time to treatment with simple antiplatelet agents, such as aspirin, a drug readily available in the first aid or pre-hospital environment, may improve survival in patients with a possible MI [3].…”

“…Between 13% and 24% of these visits for chest pain are due to acute coronary syndrome, which includes both ST-elevation myocardial infarction and non-ST-elevation acute coronary syndrome [2]. The administration of oral antiplatelet agents, such as aspirin, to individuals with non-traumatic chest pain has been shown to improve survival and is increasingly employed for chest pain in emergency care [3][4]. Given that aspirin is inexpensive and readily available, it is possible for first aid providers, such as family or friends, to initiate the administration of aspirin shortly after the onset of chest pain.…”