Medical Management of Acute Coronary Syndromes

The primary goals of the medical management of acute coronary syndromes are to restore and to maintain coronary patency. Bloodflow in totally occluded coronary arteries is restored by fibrinolysis with plasminogen activators. The ongoing thrombosis is controlled by inhibiting the coagulation cascade and platelet activity. The latter is of greater importance, as the formation of platelet-rich thrombi is the main pathophysiological mechanism leading to acute coronary syndromes. Several new classes of agents for the management of acute coronary syndromes have recently been introduced including fibrin specific plasminogen activators, direct thrombin inhibitors, low molecular weight heparins, and inhibitors of the platelet receptor glycoprotein (GP) IIb-IIIa. Recent major trials indicate that the use of these new agents may lend to a significant decrease in morbidity and mortality in patients with acute coronary syndromes.