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Siste oppdatering 01 Feb 2018

Acute Coronary Syndrome

Thrombosis and acute coronary syndrome

Acute coronary syndrome (ACS) is triggered by the rupture or ulceration of an intracoronary atherosclerotic plaque. When the endothelium is breached, blood comes in contact with plaque that is rich in tissue factor, leading to thrombus formation.35

The goal of treatment: stabilisation and prevention of recurrence

For all ACS patients, including patients with unstable angina as well as those suffering a myocardial infarction (MI), principles of care include stabilisation of the acute coronary artery lesion, relief of cardiac ischaemia, and long-term measures to prevent recurrent arterial thrombotic events, such recurrent ACS or stroke.57
Platelet-rich thrombi tend to form under conditions of high-shear stress, as occurs in arterial circulation. For this reason, antiplatelet agents are an essential component in the treatment of ACS to suppress platelet activation as the coronary lesion evolves. The course of recovery in ACS involves spontaneous, mechanical, or pharmacologic thrombolysis. Clot lysis is associated with hypercoagulability, as thrombin molecules are exposed during the process. This sets the stage for recurrent thrombosis and possible vessel reocclusion. For this reason, anticoagulant therapy is critical during the acute phase of treatment.57
The combination of antiplatelet and anticoagulant therapy is more effective than either alone.58

Learn more about thrombosis with our Animated Thrombosis Overviews .

  • 35 - Fuster V, Moreno PR, Fayad ZA, Corti R, Badimon JJ. Atherothrombosis and high-risk plaque: part I: evolving concepts. J Am Coll Cardiol. 2005;46(6):937-954.
  • 57 - Gelfand EV, Cannon CP. Acute coronary syndrome. In: Colman RW, Clowes AW, George JN, Goldhaber SZ, Marder VJ, eds. Hemostasis and Thrombosis: Basic Principles and Clinical Practice. 5th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2006:1387-1404.
  • 58 - Bassand JP, Hamm CW, Ardissino D, et al; Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007;28(13):1598-1660.
Acute coronary syndrome
An umbrella term used to cover any group of clinical symptoms compatible with an acute heart attack. The subtypes of acute coronary syndrome include unstable angina (in which the heart muscle is not damaged), and two forms of heart attack in which the heart muscle is damaged. These latter types are named according to the appearance of the electrocardiogram as non-ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI).
Enzyme in the blood clotting cascade that promotes the formation of blood clots.
Formation of a clot inside a blood vessel.