The Spectrum of Thrombin in Acute Coronary Syndromes

- Thrombin generation and activity may be a significant risk factor for thrombosis.
- Thrombin has proinflammatory effects mediated via PAR 1 and PAR 3 receptors.
- A combination of anti-thrombin and anti-platelet therapies may be beneficial.
- Studies are needed to define the combination and dose of anti-thrombotic therapies.

The role of thrombin in vascular physiology and pathophysiology continues to impact our understanding of many cellular processes and systems including the function of platelets, endothelial cells, smooth muscle cells, leukocytes and the regulation of the coagulation cascade. Recent acute coronary syndrome clinical trial results that have compared the use of parenteral or oral anticoagulants versus or in combination with anti-platelet agents have forced a reexamination of the importance of thrombin activity in influencing patient outcomes, particularly in the area of secondary prevention. The debate of the need to include oral anticoagulation as a concomitant or replacement therapy to an antiplatelet regimen as a means to improve patient outcomes requires further examination and larger prospective clinical trials.