Drug interactions in the setting of acute coronary syndromes and dual anti-platelet therapy

Modern treatment of acute coronary syndromes (ACS) with or without ST-segment elevation involves the use of at least five pharmacological groups during the acute phase, namely anti-platetet agents (including aspirin and clopidogrel), anti-thrombotic agents (unfractionated heparin, enoxaparin or fondaparinux), beta-blockers and/or calcium channel blockers, ACE inhibitors, and statins. Long term treatment also involves the same combination of drugs, except anti-thrombins. Few interactions have been described between these drugs. In particular, interactions between clopidogrel and statins described in vitro have never been shown to have any clinical implications. In fact, the two drugs have been shown clinically to have an additional effect. Non-steroidal anti-inflammatory drugs should, however, be used with caution, due to possible interactions with aspirin.