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European Heart Journal Advance Access originally published online on June 1, 2009
European Heart Journal 2009 30(14):1695-1702; doi:10.1093/eurheartj/ehp230
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

New antithrombotic agents: are they needed and what can they offer to patients with a non-ST-elevation acute coronary syndrome?

Frans Van de Werf*

Department of Cardiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium

Received 25 February 2009; revised 15 April 2009; accepted 8 May 2009; online publish-ahead-of-print 1 June 2009.

* Corresponding author. Tel: +32 16 34 34 72, Fax: +32 16 34 34 67, Email: frans.vandewerf{at}uz.kuleuven.ac.be

Antithrombotic therapy is a cornerstone of treatment for non-ST-segment elevation acute coronary syndromes, as demonstrated in numerous clinical trials. Long-term oral antiplatelet therapy targeting specific platelet activation pathways has demonstrated significant long-term benefits, whereas antithrombin use is limited to the acute setting. Despite proven efficacy of long-term dual oral antiplatelet therapy with aspirin and clopidogrel, residual morbidity and mortality is considerable. This may be partly due to incomplete inhibition of platelet activation with current agents and/or lack of long-term anticoagulant therapy. Improvements in patient outcomes could be achieved by developing agents that inhibit other platelet activation pathways or by adding new anticoagulants such as oral anti-IIa or anti-Xa agents for a prolonged period of time after the acute event. This review describes the rationale behind and the current status of the trials with new antithrombotic agents.

Key Words: Non-ST-segment elevation acute coronary syndromes • Aspirin • Clopidogrel • Thrombin • Antiplatelet agents • Anticoagulants


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