The central importance of platelets in the pathogenesis of acute coronary syndromes (ACS) has increasingly been recognized over the past few years. Therefore in the last decade, a series of novel antiplatelet agents has been developed and our understanding of the role of the older agents has expanded as well. Platelets have intensively been studied not only for the elucidation of pathophysiologic mechanisms of disease, but also as central targets in the castrametation of therapeutic interventions in the field of throm-botic diseases. There is now overwhelming evidence that various classes of antiplatelet agents improve survival and reduce myocardial infarction in patients suffering an ACS (with or without ST-segment elevation) and in those undergoing percutaneous coronary intervention (PCI). This chapter will review the background, rationale, and data-driven evidence behind the applicability of the main antiplatelet classes of drugs approved for clinical use (aspirin, thienopyridines, and platelet glycoprotein [GP] IIb/IIIa antagonists) for the treatment of non-ST elevation ACS and highlight some of the most relevant aspects of their clinical use.
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