Clinical Approach to Anti-Thrombotic Pre-Treatment for Patients with Acute Coronary
Syndromes (ACS)

The wide availability of drugs effective in reducing cardiovascular events together with the use of myocardial revascularization have greatly improved the prognosis of patients with acute coronary syndromes.
The combination of antithrombotic drugs to be administered before the visualization of the coronary tree and before the choice of the consequent therapeutic strategy can allow to anticipate an optimal treatment, but may also expose the patients to a risk of bleeding that may significantly weigh on their prognosis, even more than the expected theoretical benefit. In non ST-elevation acute coronary syndromes patients in particular, we propose a "selective pre-treatment" with P2Y₁₂ inhibitors, based on the ischemic risk, on the bleeding
risk and on the scheduled timing of the execution of coronary angiography.
Much of the problems concerning this issue would be resolved by an early access to coronary angiography, particularly for patients at higher ischemic and bleeding risk.
Key words: acute coronary syndromes; coronary artery disease; myocardial revascularization; antiplatelet agents; anticoagulant agents; haemorrhage.