Am J Cardiovasc Dis 2011;1(3):255-263

Review Article
Antithrombotic therapy in patients with acute coronary syndromes: a
balance between protection from ischemic events and risk of bleeding

Giuseppe Patti, Annunziata Nusca

Campus Bio-Medico University of Rome, Rome, Italy.

Received August 6, 2011; accepted September 7, 2011; Epub September 10, 2011; published September 30, 2011

Abstract: Platelet activation plays a primary role in the pathogenesis of acute coronary syndromes (ACS); thus,
antithrombotic therapy with aspirin and clopidogrel represents the mainstay of treatment in those patients. However, low
clopidogrel response has become a contemporary issue in interventional cardiology, increasing the risk of ischemic
events and significantly worsening short- and long-term prognosis after coronary stenting. Alternative approaches to
overcome this phenomenon have been investigated as well as increase in the loading and maintenance clopidogrel
doses, reloading patients already on chronic therapy, use of newer and more effective antiplatelet agents. Otherwise a
more aggressive antiplatelet treatment may lead to possible increase in bleeding complications. A strategy of an
individualized antiplatelet therapy according to point-of-care platelet function tests may represent the optimal approach to
balance both ischemic and hemorrhagic risk. (AJCD1108001).

Keywords: Antithrombotic therapy, acute coronary syndromes, platelet reactivity, bleeding risk

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Address all correspondence to:
Giuseppe Patti, MD
Department of Cardiovascular Sciences
Campus Bio-Medico University of Rome
Via Alvaro de Portillo, 200, 00128 Rome, Italy.
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