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The 'Dual-Pathway' Strategy After Acute Coronary Syndrome: Rivaroxaban and Anti-platelet Agents in the ATLAS ACS 2-TIMI 51 Trial.
MedLine Citation:
PMID:  24894120     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Acute coronary syndrome (ACS) is a medical emergency often associated with an occlusive coronary event with consequent myocardial underperfusion. Patients require immediate antiplatelet therapy and long-term antithrombotic prophylaxis to reduce the risk of recurrence. Acetylsalicylic acid alone or in combination with a platelet P2Y12 inhibitor (dual antiplatelet therapy) has become the clinically accepted antithrombotic prophylaxis for patients post ACS. Historically, studies assessing the utility of adding oral anticoagulants have not demonstrated a clinical benefit with regard to acceptable bleeding risk. Studies with vitamin K antagonists such as warfarin demonstrated a potential to reduce the risk for subsequent death by reinfarction but this benefit was offset by increases in bleeding. Results from studies of two targeted non-vitamin K antagonist oral anticoagulants also proved disappointing, with little or no apparent reduction in the rate of ischemic events seen. However, the recent ATLAS studies assessing rivaroxaban (an oral Factor Xa inhibitor) in patients with ACS demonstrated a reduction in the composite endpoint of deaths from cardiovascular causes, myocardial infarction, or stroke, and a reduction in the rate of stent thrombosis. This review provides an overview of the pivotal studies in which the addition of oral anticoagulants to antiplatelet therapy (the so-called 'dual-pathway' approach) has been investigated for the management of patients post ACS, and considers the results of the ATLAS studies and their potential impact on the management of patients after an acute event. This article is protected by copyright. All rights reserved.
Authors:
Marc Cohen; Deepa Iyer
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-6-4
Journal Detail:
Title:  Cardiovascular therapeutics     Volume:  -     ISSN:  1755-5922     ISO Abbreviation:  Cardiovasc Ther     Publication Date:  2014 Jun 
Date Detail:
Created Date:  2014-6-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101319630     Medline TA:  Cardiovasc Ther     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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