New data in treatment of acute coronary syndromes

Background Anticoagulants are important in the treatment of acute coronary syndromes (ACS). When given in combination with aspirin, unfractionated hep arin (UHF) improves the clinical outcome in patients who have ACS without S T-segment elevation. UHF also has potential benefits when administered in c onjunction with fibrinolytic agents, especially those that are fibrin-speci fic. The anticoagulant effect of standard heparin is unpredictable, and exc essive bleeding complications have been observed in nearly all trials. Methods New anticoagulants, including direct antithrombins, low-molecular-w eight heparins, and more recently, agents with a pure anti-Factor Xa effect , have been tested in patients with ACS and found to have varying degrees o f clinical relevance. Results One new synthetic pentasaccharide, Org31540/SR90107A, an antithromb in III-binding selective inhibitor of Factor Xa, has been studied in more t han 300 patients with acute myocardial infarction with ST-segment elevation (PENTALYSE trial). In an ongoing trial (PENTUA), Org31540/SR90107A is bein g compared with enoxaparin in patients with ACS, with and without ST-segmen t elevation. Conclusions Org31540/SR90107A has shown promising results in ACS with ST-se gment elevation. Efficacy in ACS without ST-segment elevation is currently under evaluation.