Thrombosis and Inflammation in Acute Coronary Syndromes

Platelet Inhibitors for the Treatment of Acute Coronary Syndromes

Author(s): Hasan Gungor and Ceyhun Ceyhan

Pp: 105-120 (16)

DOI: 10.2174/9781681080291115010009

* (Excluding Mailing and Handling)

Abstract

Acute coronary syndrome (ACS) is associated with significant morbidity, mortality and it is a major public health problem. The primary pathophysiological mechanism of the ACS is the response to vascular injury such as atherosclerotic plaque rupture or endothelial monolayer erosion that triggers platelet activation and aggregation leading to platelet-rich thrombi. These platelet-rich thrombi impair blood flow and result in ischemia. Inhibition of platelet aggregation by medical treatment prevents formation and progression of thrombotic process. Antiplatelet therapy is indispensible in the early and long-term management of patients with ACS. Current platelet inhibitors are thromboxane inhibitors (aspirin), P2Y12 inhibitors (ticlopidine, clopidogrel, prasugrel, ticagrelor, cangrelor and elinogrel) and protease-activated receptor antagonists (vorapaxar and atopaxar). The aim of this chapter is to discuss anti platelet therapy in ACS.


Keywords: Acute coronary syndrome, antiplatelet therapy, aspirin, atherosclerosis, atoxapar, cangrelor, coronary artery disease, clopidogrel, elinogrel, inflammation, irreversible, platelets, prasugrel, protease-activated receptor, reversible, thienopyridine, thrombosis, thromboxane, ticagrelor, voraxapar.

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      • 17. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
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      • 11. app/Models/ContentAccess.php:647
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      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 14. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
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      280μsalphaeurekaselec_live_10_06_2022ContentAccess.php#647
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      • 11. app/Models/ContentAccess.php:647
      • 12. app/Http/Controllers/ChapterController.php:1478
      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 14. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51595851 and j.to_ip >=51595851 )) and ((j.from_date <= 1740458902 and j.to_date >= 1740458902 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 7247) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51595851 and j.to_ip >=51595851 )) and ((j.from_date <= 1740458902 and j.to_date >= 1740458902 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 7247) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51595851 and j.to_ip >=51595851 )) and ((j.from_date <= 1740458902 and j.to_date >= 1740458902 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 7247)
      580μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 1699 and `b`.`banner_from_date` <= 1740458902 and `b`.`banner_to_date` >= 1740458902 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.47msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 1699
      • 3: 1740458902
      • 4: 1740458902
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='cee8f5cf4ce829cca0178ce20d24455c'
      280μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    20Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        ZPrmehvNCapfXeFxXFzBTFJ9HNn1N5J9KkeCZwjb
        uc_cart_id
        cee8f5cf4ce829cca0178ce20d24455c
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/7247" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/7247
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6Im9iT3htMi9HbEI3YkVkU1RJUWJleXc9PSIsInZhbHVlIjoiY1Y5bG50Zm5wTHExTlZmazNTYkFVSnAwU2g5VGl4STBmYUpmRUV0dnUybz0iLCJtYWMiOiJkOGZlODllYzBjYTViMDlmYzhjMTc3NjYzNjkyMDliNjdlYjMzMTIyZmU5OGU1ZGYzNzE3NmU2ZjdhOTcwZGE2IiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6Im9iT3htMi9HbEI3YkVkU1RJUWJleXc9PSIsInZhbHVlIjoiY1Y5bG50Zm5wTHExTlZmazNTYkFVSnAwU2g5VGl4STBmYUpmRUV0dnUybz0iLCJtYWMiOiJkOGZlODllYzBjYTVi" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Tue, 25 Feb 2025 04:48:22 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6Inp6NHdqK2x0UVhWSFA5bXRRaElxWXc9PSIsInZhbHVlIjoiYlp0Q2luUEZ1Vkx0ZGdHTWkwTGRGcU1tWE80NUM5M05zSUVWaDBYWEZoSVlRTjFxdVk1NFpENzFmK3NrZ3JqWmdHY3lPeURpUFBWbkQwa29EbngwTmdHQVFmVEVpUDJaNFAzbkQvaUx4T0ltYXJ2R2EyZTdUQTc4Ykk2QmErREoiLCJtYWMiOiI4YTQ1MzhiMGZiMmFhNTM1ZTlmMmIzN2Q5MmZiMTQ2Mzk4MjliMjBlMWU5MTVhNDc2MmRmNWM5OTIzZTNiYTBkIiwidGFnIjoiIn0%3D; expires=Thu, 27 Feb 2025 16:48:22 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6Inp6NHdqK2x0UVhWSFA5bXRRaElxWXc9PSIsInZhbHVlIjoiYlp0Q2luUEZ1Vkx0ZGdHTWkwTGRGcU1tWE80NUM5M05zSUVWaDBYWEZoSVlRTjFxdVk1NFpENzFmK3NrZ3JqWmdHY3lPe" 1 => "alphaeurekaselectnet_session=eyJpdiI6IkFVVXBrR2VLeEc5R0Q1UEVxemlyYUE9PSIsInZhbHVlIjoiWHp6RjRVL3psT1JtaXVWZm0rNkFwL2U3TkdNOGc4YTRPUW85YWU2YjF2dSs5OU5Cc3ByVmJENlUvUXQ1Z2FWbmdGRlVlaHBGdDBxL2RUMjl1RkI1SHEzdm41U21XYnVDY2c1QmE1NzFPOFZHN05OemZmSm0vWGlKYndZbjBHdVYiLCJtYWMiOiI0MTE1MDQxOTQyMWRmMmE5NDhiYWExYmJiMGI1NjZmZDJjMDRkMTkzYzgzYTZjNjg5Y2IyOGY5YWI5MmZkNDgzIiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6IkFVVXBrR2VLeEc5R0Q1UEVxemlyYUE9PSIsInZhbHVlIjoiWHp6RjRVL3psT1JtaXVWZm0rNkFwL2U3TkdNOGc4YTRPUW85YWU2YjF2dSs5OU5Cc3ByVmJENlU" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6Inp6NHdqK2x0UVhWSFA5bXRRaElxWXc9PSIsInZhbHVlIjoiYlp0Q2luUEZ1Vkx0ZGdHTWkwTGRGcU1tWE80NUM5M05zSUVWaDBYWEZoSVlRTjFxdVk1NFpENzFmK3NrZ3JqWmdHY3lPeURpUFBWbkQwa29EbngwTmdHQVFmVEVpUDJaNFAzbkQvaUx4T0ltYXJ2R2EyZTdUQTc4Ykk2QmErREoiLCJtYWMiOiI4YTQ1MzhiMGZiMmFhNTM1ZTlmMmIzN2Q5MmZiMTQ2Mzk4MjliMjBlMWU5MTVhNDc2MmRmNWM5OTIzZTNiYTBkIiwidGFnIjoiIn0%3D; expires=Thu, 27-Feb-2025 16:48:22 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6Inp6NHdqK2x0UVhWSFA5bXRRaElxWXc9PSIsInZhbHVlIjoiYlp0Q2luUEZ1Vkx0ZGdHTWkwTGRGcU1tWE80NUM5M05zSUVWaDBYWEZoSVlRTjFxdVk1NFpENzFmK3NrZ3JqWmdHY3lPe" 1 => "alphaeurekaselectnet_session=eyJpdiI6IkFVVXBrR2VLeEc5R0Q1UEVxemlyYUE9PSIsInZhbHVlIjoiWHp6RjRVL3psT1JtaXVWZm0rNkFwL2U3TkdNOGc4YTRPUW85YWU2YjF2dSs5OU5Cc3ByVmJENlUvUXQ1Z2FWbmdGRlVlaHBGdDBxL2RUMjl1RkI1SHEzdm41U21XYnVDY2c1QmE1NzFPOFZHN05OemZmSm0vWGlKYndZbjBHdVYiLCJtYWMiOiI0MTE1MDQxOTQyMWRmMmE5NDhiYWExYmJiMGI1NjZmZDJjMDRkMTkzYzgzYTZjNjg5Y2IyOGY5YWI5MmZkNDgzIiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6IkFVVXBrR2VLeEc5R0Q1UEVxemlyYUE9PSIsInZhbHVlIjoiWHp6RjRVL3psT1JtaXVWZm0rNkFwL2U3TkdNOGc4YTRPUW85YWU2YjF2dSs5OU5Cc3ByVmJENlU" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "ZPrmehvNCapfXeFxXFzBTFJ9HNn1N5J9KkeCZwjb" "uc_cart_id" => "cee8f5cf4ce829cca0178ce20d24455c" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/7247" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-25 04:48:22GET/chapter/72471121922