Nonplatelet mechanisms may have a role in these events; therefore, other drugs have been tested. Warfarin sodium has been used among patients with ACS in combination with aspirin vs aspirin alone, showing a significant decrease in recurrent events but also a significant increase in major bleeding events with the combined treatment.2
In contrast to warfarin, novel oral anticoagulants (NOACs), such as direct thrombin inhibitors and anti-Xa, do not require monitoring and have minimal food and drug interactions. Moreover, compared with warfarin NOACs have demonstrated significant reductions in thrombotic events and lower rates of major bleeding events in patients having atrial fibrillation and in patients undergoing knee and hip surgery.3 In recent years, several phase 2 and phase 3 trials of NOACs for the treatment of patients with ACS have been published, with most of the patients receiving dual antiplatelet treatment. Although recent detailed review articles have described the pros and cons of the use of NOACs in ACS,4,5 the available evidence has not been quantitatively summarized.