Antithrombotic therapy in acute coronary syndromes setting: new clinical guidelines, controversial issues and the role of prehospital stage

Abstract

Antithrombotic therapy is a cornerstone of acute coronary syndromes treatment, preventing coronary artery thrombosis development and progression. Early administration of P2Y12 receptor antagonists to patients with acute coronary syndromes (ACS) at the prehospital stage is a common practice and has been supported by the European and Russian Societies of Cardiology guidelines for many years despite the lack of definite evidence for its benefit. Recent clinical trials and registers on ACS treatment have shown no benefit and higher prevalence of bleeding related to the early start of P2Y12 receptor antagonists in NSTE-ACS patients. The latest European and Russian Societies of Cardiology guidelines do not recommend prehospital administration of P2Y12 receptor antagonists. The article highlights the antithrombotic therapy in acute coronary syndromes setting, recent ESC guidelines and its possible implementation in common practice.