Journal Article

Antiplatelet drugs in the treatment of acute coronary syndromes: Focus on cyclooxygenase inhibitors

J.M. Cruz-Fernandez

in European Heart Journal Supplements

Published on behalf of European Society of Cardiology

Volume 3, issue suppl_I, pages I23-I30
Published in print August 2001 | ISSN: 1520-765X
Published online August 2001 | e-ISSN: 1554-2815 | DOI: http://dx.doi.org/10.1016/S1520-765X(01)90103-8
Antiplatelet drugs in the treatment of acute coronary syndromes: Focus on cyclooxygenase inhibitors

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Despite its widespread use and documented efficacy in the treatment of acute coronary syndromes, aspirin has some limitations and the search for more effective and safer alternatives continues. This article analyses some current aspects of the treatment of these syndromes with the cyclooxygenase inhibitor triflusal.

Triflusal inhibits platelet cyclooxygenase activity but does not interfere significantly with endothelial synthesis of prostacyclin via the cyclooxygen ase-2 pathway. This drug also increases nitric oxide synthesis by neutrophils, and decreases the activity of nuclear transcription factor NF-B more than aspirin does. Moreover, triflusal inactivates intraplatelet phosphodiesterase and potentiates the antiaggregant effect of cAMP and cGMP, since it interferes with the degradation of these compounds. These pharmacological differences make triflusal potentially more effective and safer than aspirin.

For unstable angina or non-Q-wave myocardial infarction, triflusal is as effective as aspirin. In a multicentre study of more than 2000 patients with acute myocardial infarction, triflusal was as effective as aspirin, and had a better safety profile, significantly decreasing (> 60%) the incidence of cerebrovascular accidents. The patients likely to benefit most from treatment with triflusal were those receiving fibrinolytic treatment, patients older than 65 years, and those receiving concomitant treatment with angiotensin-converting enzyme inhibitors.

Triflusal is currently a valid alternative to aspirin for unstable angina, and for acute myocardial infarction it is the only alternative drug shown to be as effective as aspirin but safer.

Keywords: Acute coronary syndromes; antiplatelet agents; aspirin; cyclooxygenase inhibitors; triflusal

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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