The Latest and Greatest in Anticoagulation — Still Not a Good Idea After ACS

The burgeoning use of new oral anticoagulants (e.g., dabigatran, rivaroxaban, apixaban) has rekindled interest in whether these agents, combined with standard antiplatelet therapy, could reduce thrombotic events after acute coronary syndromes (ACS). To synthesize the current evidence base, researchers performed a meta-analysis of seven trials in which 31,286 ACS patients were randomized to placebo or a new oral anticoagulant, either an anti-Xa or direct thrombin inhibitor. All patients also received antiplatelet therapy, and most received dual antiplatelet therapy with aspirin and a thienopyridine.

Although the risk for major ischemic events was significantly lower in recipients of new-generation oral anticoagulants than in placebo recipient…