{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T03:10:36Z","timestamp":1761102636154,"version":"build-2065373602"},"reference-count":47,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,12,13]],"date-time":"2013-12-13T00:00:00Z","timestamp":1386892800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:p>Dual antiplatelet therapy has become a mainstay of long\u2010term management of patients after an acute coronary syndrome (<jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>). Mortality for these patients remains high despite current evidence\u2010based treatment strategies. The coagulation cascade plays a role in the pathophysiology of <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>, and trials with warfarin in combination with dual antiplatelet therapy have found decreased rates of ischemic events at the expense of increased bleeding risk. Novel oral anticoagulants (<jats:styled-content style=\"fixed-case\">NOAC<\/jats:styled-content>s) in the direct factor Xa (<jats:styled-content style=\"fixed-case\">FX<\/jats:styled-content>a) inhibitor and direct thrombin inhibitor (<jats:styled-content style=\"fixed-case\">DTI<\/jats:styled-content>) categories have been evaluated in combination with standard post\u2010<jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> therapy. Rivaroxaban, a <jats:styled-content style=\"fixed-case\">FX<\/jats:styled-content>a inhibitor, reduced the rates of ischemic events but increased major bleeding rates. Apixaban did not decrease the rates of ischemic events and also increased major bleeding rates. Other <jats:styled-content style=\"fixed-case\">FX<\/jats:styled-content>a inhibitors have not been studied in the long\u2010term management of <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> (e.g., otamixaban), are not currently being studied in ongoing phase <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> trials (e.g., <jats:styled-content style=\"fixed-case\">TAK<\/jats:styled-content>\u2010442), or have been discontinued by the manufacturer (e.g., darexaban). The <jats:styled-content style=\"fixed-case\">DTI<\/jats:styled-content> dabigatran had a 2\u2010 to 4\u2010fold increased risk of major bleeding with unclear benefit for reducing ischemic events. The factor <jats:styled-content style=\"fixed-case\">IX<\/jats:styled-content>a inhibitor pegnivacogin is an <jats:styled-content style=\"fixed-case\">RNA<\/jats:styled-content>\u2010based aptamer that has been studied in patients undergoing cardiac catheterization but has not been studied for long\u2010term post\u2010<jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> management. The European Society of Cardiology Working Group on Thrombosis recommends the use of newer antiplatelet agents over addition of <jats:styled-content style=\"fixed-case\">NOAC<\/jats:styled-content>s. Additional guidelines are available to guide management in patients requiring triple antithrombotic therapy but do not provide definitive recommendations on <jats:styled-content style=\"fixed-case\">NOAC<\/jats:styled-content>s. Many questions remain about the place of <jats:styled-content style=\"fixed-case\">NOAC<\/jats:styled-content>s for long\u2010term post\u2010<jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> management. Recent trials have evaluated double versus triple antithrombotic therapy to balance efficacy and bleeding risk, but they did not include <jats:styled-content style=\"fixed-case\">NOAC<\/jats:styled-content>s. It also remains unclear if <jats:styled-content style=\"fixed-case\">NOAC<\/jats:styled-content>s hold a place in post\u2010<jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> therapy in the era of more potent antiplatelet agents such as prasugrel and ticagrelor.<\/jats:p>","DOI":"10.1002\/phar.1375","type":"journal-article","created":{"date-parts":[[2013,12,13]],"date-time":"2013-12-13T07:34:50Z","timestamp":1386920090000},"page":"590-604","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Role of Novel and Emerging Oral Anticoagulants for Secondary Prevention of Acute Coronary Syndromes"],"prefix":"10.1002","volume":"34","author":[{"given":"Valerie S.","family":"Ganetsky","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice Philadelphia College of Pharmacy University of the Sciences Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane E.","family":"Hadley","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice Philadelphia College of Pharmacy University of the Sciences Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyan F.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice Philadelphia College of Pharmacy University of the Sciences Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,12,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318235eb4d"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa010746"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706482"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904327"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq326"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2002-03-0954"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi485"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-143-4-200508160-00005"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61751-7"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-3083"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1160\/TH09-06-0361"},{"volume-title":"Pradaxa (dabigatran) package insert","year":"2012","author":"Boehringer Ingelheim Pharmaceuticals","key":"e_1_2_8_13_1"},{"volume-title":"Apixaban (Eliquis) package insert","year":"2012","author":"Bristol\u2010Meyers Squibb","key":"e_1_2_8_14_1"},{"volume-title":"Rivaroxaban (Xarelto) package insert","year":"2011","author":"Janssen Pharmaceuticals, Inc.","key":"e_1_2_8_15_1"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2292"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.02.008"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60738-8"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14287-0"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1112277"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.01.066"},{"key":"e_1_2_8_22_1","unstructured":"Rivaroxaban FDA Draft Briefing Document for the Cardiovascular and Renal Drugs Advisory Committee (CRDAC). 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