Antithrombotic Therapy of Acute Coronary Syndromes - Acute and Long-term

Antithrombotic therapy is an important component of the treatment of patients with acute coronary syndromes (ACS). While anticoagulation is usually only needed in the acute phase, the use of antiplatelet drugs is of great importance in the acute, maintenance and long-term treatment of ACS. Currently, dual antiplatelet therapy (DAPT) with ASA and a potent P2Y12 inhibitor for 12 months is standard therapy. The increased ischemic risk, especially in the initial phase after ACS, decreases over time, whereas the cumulative bleeding risk remains elevated. Therefore, abbreviated DAPT and DAPT de-escalation strategies in ACS patients have been examined in a large number of studies and meta-analyses. The current 2023 ESC guidelines for the management of acute coronary syndromes have incorporated and evaluated the new therapeutic concepts and extensive study data on antithrombotic therapy after ACS and provide treatment recommendations with default and alternative strategies. Treatment decisions on antithrombotic therapy after ACS should be made individually depending on the patients' ischemic and bleeding risk and, if necessary, be adjusted over time.