Anti-coagulation for Patients with Acute Coronary Syndrome

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  • Hirayama Atsushi
    Division of Cardiology, Department of Medicine, Nihon University School of Medicine

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Although the anti-platelet therapy is a standard for a patient with acute coronary syndrome with or without coronary intervention, oral anticoagulant has not been used for long time. Several trials demonstrated the beneficial effects on the prevention of reinfarction or stroke, but the risk of serious bleeding increased. Furthermore, good adherence and control of oral anticoagulant were necessary to improve the clinical outcome. So, oral anticoagulant has not been used for the patients with acute coronary syndrome; however, direct thrombin inhibitor or direct anti-Xa have been proven to be equivalent or even better to warfarin in stroke prevention for patients with atrial fibrillation (AF). These new oral anticoagulant (NOAC) has been tested in patients with acute coronary syndrome, and showed the normal dose of NOAC for stroke prevention with dual antiplatelet increased the bleeding risk, but reduced dose of NOAC might be beneficial for the secondary prevention. This combination of anticoagulant and DAPT is especially interested, because of the anti-thrombotic regimen for patients with AF and coronary heart disease who are treated by stent. Triple therapy (warfarin and DAPT) increased bleeding complication and major cardiovascular events compared to dual therapy (warfarin and single anti-platelet) in stable coronary artery disease; however, no trials in acute coronary syndrome are available right now. Furthermore, no data are available in NOAC. Until then, the appropriate combination of NOAC and anti-platelet would be chosen by the physician who assessed the risk of bleeding and thrombosis for each patient.

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