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Cardiovascular Research 1999 41(2):418-432; doi:10.1016/S0008-6363(98)00323-X
© 1999 by European Society of Cardiology
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Copyright © 1999, European Society of Cardiology

Prevention of activation of blood coagulation during acute coronary ischemic syndromes

beyond aspirin and heparin

Shannon M. Batesa and Jeffrey I. Weitzb,*

aMcMaster University and Hamilton Civic Hospitals Research Centre, Hamilton, Ontario, Canada
bHamilton Civic Hospitals Research Centre, Henderson General Division, 711 Concession Street, Hamilton, Ontario, Canada L8V 1C3

* Corresponding author. Tel.: +1-905-574-8500; fax: +1-905-575-2646; e-mail: weitzj@fhs.mcmaster.ca

Many of the acute coronary ischemic syndromes are triggered by spontaneous or mechanical disruption of atherosclerotic plaques with resultant activation of platelets and coagulation. Given the central role of platelets and thrombin in arterial thrombosis, current strategies for its prevention and treatment focus on both inhibition of platelet aggregation and control of thrombin generation and activity. Although aspirin and unfractionated heparin are the cornerstones of current treatment strategies, both have limitations. This review will describe these limitations and discuss new antithrombotic agents developed for use in acute coronary ischemic syndromes and as adjuncts for percutaneous coronary revascularization procedures.

KEYWORDS Coronary ischemic syndromes; Thrombosis; Anticoagulants; Thrombin inhibitors; Antiplatelet therapy; Heparin; Low-molecular-weight heparin; Hirudin


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