Acute coronary syndromes anticoagulants

At this stage, patients may experience symptoms of acute coronary syndrome. If endogenous anticoagulant proteins fail to halt this process, platelet aggregation continues and fibrinogen is converted to fibrin, resulting in an occlusive thrombus (Panel F). 

Percutaneous coronary intervention (PCI) such as coronary angioplasty and stent implantation has become a worldwide routine strategy for coronary arterial occlusive diseases. Along with the recognition that thrombus formation is very likely to be involved in acute coronary syndrome (ACS), selection of the optimal anticoagulant is becoming essential to achieve reliable anticoagulation for successful PCI. 

To understand the evolution of therapy of the acute coronary syndrome (ACS), which includes unstable angina, acute myocardial infarction, and interventional therapy— percutaneous coronary intervention (PCI), it is most useful to trace the historical events that provided a rationale for the use of anticoagulant and antiplatelet drugs, The focus of this chapter is upon the explosion in knowledge of the physiology of the hemostatic mechanism and will trace the rational development of therapy based upon the pathophysiology of the ACS over the past 40 years. 

The anticlotting drugs are used in the treatment of myocardial infarction and other acute coronary syndromes, atrial fibrillation, ischemic stroke, and deep vein thrombosis (DVT). The anticoagulant and thrombolytic drugs ate effective in treatment of both venous and arterial thrombosis. Antiplatelet dmgs are used primarily for treatment of arterial disease. 

Cardiovascular A 64-year-old woman treated for macular degeneration with intraocular injections of bevacizumab presented with chest pain, nausea and vomiting. After an initial diagnosis of acute coronary syndrome and anticoagulation treatment with intravenous heparin, she remained stable without chest pain or shortness of breath and with no evidence of arrhythmias. This may be the first report of an association between intraocular bevacizumab and reversible myocardial dysfunction with a pattern similar to stress-induced cardiomyopathy (also called Takotsubo cardiomyopathy or apical ballooning), although clear evidence for a causal relationship is lacking [97 ]. 

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