Estrategia invasiva en el SCASEST. Tratamiento antitrombótico

Treatment of non-ST-segment elevation acute coronary syndrome (NSTEACS) is based on anticoagulant and antiplatelet therapy along with coronary revascularization. Numerous studies have shown that an invasive strategy involving early coronary angiography and revascularization provides the best clinical outcome in high-risk patients. Associated medical treatment can change both disease prognosis and the result of coronary revascularization. To date, treatment with aspirin, clopidogrel and (unfractionated or low-molecular-weight) heparin is considered standard therapy for most patients with NSTEACS, with glycoprotein IIb/IIIa inhibitors being given to high-risk patients. However, there is still some uncertainty about treatment outcomes, timing and dosage when clopidogrel is given with a glycoprotein IIb/IIIa inhibitor. In addition, the better clinical results obtained with fondaparinux compared with enoxaparin, and the reduction in bleeding observed with bivalirudin relative to that seen with combination treatment with heparin and glycoprotein IIb/IIIa inhibitors, as reported in two recent studies, necessitate the re-evaluation of current treatment for NSTEACS.