Interv Akut Kardiol. 2015;14(1):26-30

Novel oral anticoagulants in treatment of acute coronary syndrome

Karel Kopřiva, Petr Neužil

Kardiologické oddělení, Nemocnice Na Homolce, Praha

Dual antiplatelet therapy is a standard component of secondary prevention in patients with acute coronary syndrome (ACS). In spite of this, there

remains an increased risk of myocardial infarction (MI) and cardiovascular death in these patients. Given the pathophysiological mechanism of

ACS, long-term anticoagulant therapy appears to be one of the options of how to further reduce this risk. Nowadays, novel oral anticoagulants

(NOACs) are routinely used to treat venous thrombosis as well as to prevent stroke and systemic embolism in atrial fibrillation. Several agents

of this group have been tested in clinical trials in the indication of secondary prevention in ACS. In all the trials performed, however, treatment

with NOACs was associated with an increase in the rate of bleeding complications, which limited the potential benefit of treatment in reducing

ischaemic events, and only a trial with rivaroxaban successfully completed phase III. This trial (ATLAS ACS 2–TIMI 51) with low-dose rivaroxaban

reported a favourable result in terms of the risk-benefit ratio of treatment with NOACs in ACS. The article presents an overview of performed

trials with NOACs in ACS and discusses the issue of implementation of NOACs in routine clinical practice in this indication.

Keywords: novel oral anticoagulants, acute coronary syndrome, antithrombotic therapy, secondary prevention

Published: April 20, 2015  Show citation