Diagnosis and Management of Acute Coronary Syndrome: What is New and Why? Insight From the 2020 European Society of Cardiology Guidelines

Guedeney, Paul; Collet, Jean‐Philippe

doi:10.3390/jcm9113474

Cited by 19 publications

(12 citation statements)

References 70 publications

(77 reference statements)

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“…Extended dual antithrombotic or antiplatelet regimen may be considered in case of a high-risk of an ischemic event with no high risk of bleeding. Several regimens may then be considered based on the results of the Prevention of Cardiovascular events in Patients With Prior heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarc-tion (PEGASUS-TIMI 54), the Cardiovascular Outcomes for People Using Anticoagulant Strategies (COMPASS) and the Dual Antiplatelet Therapy (DAPT) trials [40].…”

Section: Discussionmentioning

confidence: 99%

Management of Oral Anticoagulation and Antiplatelet Therapy in Post-Myocardial Infarction Patients with Acute Ischemic Stroke with and without Atrial Fibrillation

Pezzella

Mangiardi

Ferrante

et al. 2022

JCM

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The association between atrial fibrillation (AF), acute coronary syndrome (ACS), and stroke is a complex scenario in which the assessment of both thrombotic and hemorrhagic risk is necessary for scheduling an individually tailored therapeutic plan. Recent clinical trials investigating new antithrombotic drugs and dual and triple pathways in high-risk cardiovascular patients have revealed a new therapeutic scenario. In this paper, we review the burden of ischemic stroke (IS) in patients post-myocardial infarction with and without atrial fibrillation and the possible therapeutic strategies from a stroke point of view.

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Section: Discussionmentioning

confidence: 99%

Management of Oral Anticoagulation and Antiplatelet Therapy in Post-Myocardial Infarction Patients with Acute Ischemic Stroke with and without Atrial Fibrillation

Pezzella

Mangiardi

Ferrante

et al. 2022

JCM

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“…5,6 Consistently, the issue of the optimal antithrombotic therapy for the early and late management of ACS has remained an evolving debate, as pivotal randomized controlled trials (RCTs) have introduced or challenged therapeutic concepts. 1,7,8 The purpose of this review is to provide a description of the current state of evidence in the field of antithrombotic therapy for ACS, and to describe novel axes of research for the near future.…”

Section: Introductionmentioning

confidence: 99%

Antithrombotic Therapy in Acute Coronary Syndromes: Current Evidence and Ongoing Issues Regarding Early and Late Management

Guedeney

Collet

2021

Thromb Haemost

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A few decades ago, the understanding of the pathophysiological processes involved in the coronary artery thrombus formation has placed anticoagulant and antiplatelet agents at the core of the management of acute coronary syndrome (ACS). Increasingly potent antithrombotic agents have since been evaluated, in various association, timing, or dosage, in numerous randomized controlled trials to interrupt the initial thrombus formation, prevent ischemic complications, and ultimately improve survival. Primary percutaneous coronary intervention, initial parenteral anticoagulation, and dual antiplatelet therapy with potent P2Y12 inhibitors have become the hallmark of ACS management revolutionizing its prognosis. Despite these many improvements, much more remains to be done to optimize the onset of action of the various antithrombotic therapies, for further treating and preventing thrombotic events without exposing the patients to an unbearable hemorrhagic risk. The availability of various potent P2Y12 inhibitors has opened the door for individualized therapeutic strategies based on the clinical setting as well as the ischemic and bleeding risk of the patients, while the added value of aspirin has been recently challenged. The strategy of dual-pathway inhibition with P2Y12 inhibitors and low-dose non-vitamin K antagonist oral anticoagulant has brought promising results for the early and late management of patients presenting with ACS with and without indication for oral anticoagulation. In this updated review, we aimed at describing the evidence supporting the current gold standard of antithrombotic management of ACS. More importantly, we provide an overview of some of the ongoing issues and promising therapeutic strategies of this ever-evolving topic.

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“…ACS is mainly characterized by acute onset, rapid progression, and high mortality [ 3 , 4 ]. Presently, cardiovascular disease (CVD) is attributed to almost a third of global fatalities, and the most serious of them all is ACS, which results in five million hospitalizations and two hundred and seventy billion dollars cost each year in Europe and America [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Efficacy and Safety of Safflower Injection in the Treatment of Acute Coronary Syndrome

Lü

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Background. Safflower injection (SFI), a popular Chinese patent drug, is commonly used to treat acute coronary syndromes (ACSs) in China. The research seeks to scientifically estimate the clinical efficacy of SFI for ACS patients. Methods. Eight electronic databases were retrieved for eligible research from the founding date to September 8, 2020. Odds ratio (OR) was adopted to assess the total effective rate, ECG improvement, and adverse reaction, and mean difference (MD) was used for assessing the hemorheology indexes as well as the LVEF. Results. Sixteen randomized controlled trials involving 1620 sufferers with ACS were incorporated. The outcomes showed that, in comparison to conventional medication alone, SFI combined with conventional treatment remarkably enhanced the total effective rate (OR = 3.66, 95% CI [2.73, 4.90], P < 0.00001 ), ECG improvement (OR = 2.85, 95% CI [2.04, 3.99], P < 0.00001 ), and LVEF (MD = 5.13, 95% CI [3.73, 6.53], P < 0.00001 ). Moreover, SFI combined with conventional treatment significantly decreased hemorheology indexes including BV (MD = −0.95, 95% CI [−1.76, −0.13], P = 0.02 ), HCT (MD = −2.37, 95% CI [−3.25, −1.50], P < 0.00001 ), FIB (MD = −0.44, 95% CI [−0.60, −0.29], P < 0.00001 ), and PAR (OR = −7.65, 95% CI [−10.16, −5.14], P < 0.00001 ). However, no notable contrast was observed to link the experimental and the control team for PV (MD = −0.42, 95% CI [−0.83, 0.00], P = 0.05 ) and adverse reactions (OR = 0.59, 95% CI [0.13, 2.74], P = 0.50 ). Conclusion. Despite the limitations that existed in this meta-analysis, the outcomes demonstrated that SFI and conventional combined medication is an effective and relatively safe therapy for ACS sufferers.

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Diagnosis and Management of Acute Coronary Syndrome: What is New and Why? Insight From the 2020 European Society of Cardiology Guidelines

Cited by 19 publications

References 70 publications

Management of Oral Anticoagulation and Antiplatelet Therapy in Post-Myocardial Infarction Patients with Acute Ischemic Stroke with and without Atrial Fibrillation

Management of Oral Anticoagulation and Antiplatelet Therapy in Post-Myocardial Infarction Patients with Acute Ischemic Stroke with and without Atrial Fibrillation

Antithrombotic Therapy in Acute Coronary Syndromes: Current Evidence and Ongoing Issues Regarding Early and Late Management

Therapeutic Efficacy and Safety of Safflower Injection in the Treatment of Acute Coronary Syndrome

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