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[PubMed]2. Ann Intern Med. [PubMed]22. AbstractPatients with acute coronary syndrome (ACS) continue to be at risk for recurrent ischemic events, despite an early invasive strategy and the use of dual antiplatelet therapy. [PubMed]23. 2013;112(12):19731979. Husted SE, Wallentin L, Lagerqvist B, Kontny F, Sthle E, Swahn E. Only the ATLAS ACS 2-TIMI 51 trial has shown rivaroxaban to reduce ischemic events including mortality, albeit at the cost of increased bleeding.Since the ATLAS 2 study was performed, two potent antiplatelet agents, prasugrel and ticagrelor, have been introduced for the management of ACS.

[PubMed]8. 2006;354(14):14641476. January 27, 2012.15. More prolonged administration of the low molecular weight heparin dalteparin reduced ischemic events over the first 45 days of treatment but not when used for a longer duration.7 Until recently, the only oral anticoagulant available was warfarin, which has been studied in several clinical trials of patients with ACS. 2008;24(10):27572765. This may have been another factor contributing to the increased bleeding complications noted in this study. The desired outcome would be a further reduction of recurrent cardiovascular events with low or acceptable levels of bleeding complications. Dewilde WJ, Oirbans T, Verheugt FW, et al. Warfarin, aspirin, or both after myocardial infarction. N Engl J Med.

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