Pharmacy Practice

Despite important advances in the treatment of acute coronary syndromes (ACS) and venous thromboembolism (VTE), these conditions continue to exact a heavy toll. Cardiovascular diseases, including the ACS components unstable angina, non–ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction, are leading causes of death and morbidity in developed countries. VTE affects approximately 1 in 1000 people each year in the United States. Although antithrombotic therapy is the cornerstone of treatment for both conditions, the choice of agent has become increasingly complex. For decades, aspirin, heparin, low-molecular-weight heparin, and vitamin K antagonists, such as warfarin, were the only options available. In the past few years, however, advances in the understanding of the coagulation cascade have transformed drug development in the field of cardiology. A synthetic inhibitor of factor Xa (fondaparinux) and derivatives of hirudin (desirudin, bivalirudin) have been approved, other indirect and direct inhibitors of factor Xa and direct thrombi