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Thrombin receptor antagonists may become an important antiplatelet therapy for coronary artery disease

Frans Van de Werf
DOI: http://dx.doi.org/10.1093/eurheartj/ehq283 ehq283 First published online: 30 August 2010

This editorial refers to ‘Double-blind, placebo-controlled Phase II studies of the protease-activated receptor 1 antagonist E5555 (atopaxar) in Japanese patients with acute coronary syndrome or high-risk coronary artery disease’, by S. Goto et al. doi:10.1093/eurheartj/ehq320

Acute coronary syndromes (ACS), which comprise unstable angina (UA), non-ST-elevation acute myocardial infarction (NSTEMI), and ST-segment elevation acute myocardial infarction (STEMI), are a major public health problem. The primary pathophysiological mechanism responsible for the clinical manifestations of ACS involves the formation of platelet-rich thrombi that develop in response to vascular injury (atherosclerotic plaque rupture or erosion of endothelial monolayer). Current management of ACS consists of acute administration of antiplatelet and anticoagulant agents, revascularization procedures [plus reperfusion therapy with lytic agents or percutaneous coronary intervention (PCI) in the case of STEMI], and long-term treatment with antiplatelet agents as well as statins and agents inhibiting the angiotensin pathways. Despite the frequent use of these guidelines and recommended treatments, the residual acute and long-term morbidity and mortality associated with ACS remain high. In a paper presented at the Hotline Session of the ESC in Stockholm 2010 and published in the issue of this journal from the GRACE registry, long-term outcome data after ACS are reported.1 Mortality rates at 5 years of 19% in STEMI, 22% in NSTEMI, and, most astonishing, 17% in patients with UA were observed. More than 80% of the …

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