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Early and effective antithrombotic therapy is critical and has been shown to improve mortality in most patients with acute coronary syndrome. Achieving early effective platelet inhibition and anticoagulation, with minimal risk, is particularly important in those high-risk patients with CS as the mortality remains high at approximately 50%. However, patients with CS are at high risk for both early thrombotic as well as bleeding events and striking the right balance remains a challenge due to a multitude of factors related to drug administration, metabolism and mechanical issues related to therapeutic interventions such as increasing use of mechanical circulatory support (MCS). This review therefore aims to provide an overview of the current practice, the underlying challenges and existing evidence on safety, efficacy and outcomes of adjunctive antiplatelet and antithrombotic therapy in patients with acute myocardial infarction (AMI) complicated by CS and discusses the use of parenteral platelet inhibitors.<\/jats:p>","DOI":"10.1007\/s00392-025-02619-2","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T05:53:57Z","timestamp":1741067637000},"page":"1237-1245","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Antiplatelet therapy in acute myocardial infarction complicated by cardiogenic shock"],"prefix":"10.1007","volume":"114","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0992-0236","authenticated-orcid":false,"given":"Angela","family":"Dettling","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Huber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steen D.","family":"Kristensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Aradi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Schrage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Clemmensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,4]]},"reference":[{"key":"2619_CR1","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1007\/s00392-017-1192-0","volume":"107","author":"T Backhaus","year":"2018","unstructured":"Backhaus T, Fach A, Schmucker J, Fiehn E, Garstka D, Stehmeier J, Hambrecht R, Wienbergen H (2018) Management and predictors of outcome in unselected patients with cardiogenic shock complicating acute ST-segment elevation myocardial infarction: results from the Bremen STEMI Registry. 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KH is National Coordinator Investigsator of SOS-AMI (selatogrel, Idorsia) in Austira. BS has received speaker fees from Abbott, Abiomed and AstraZeneca as well as research funding from Abiomed, the DFG and the EKFS; outside of the submitted work. PC has previously or currently been involved in research contracts, consulting, speakers bureau or received research and educational grants from: Abbott, AstraZeneca, Aventis, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Eli-Lilly, Evolva, Fibrex, Idorsia, Janssen, Merck, Myogen, Medtronic, Mitsubishi Pharma, The Medicines Company, Nycomed, Organon, Pfizer, Pharmacia, Philips, Regado, Sanofi, Searle, Servier, ViFor Pharma. The other authors have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}