{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:44:59Z","timestamp":1789469099493,"version":"build-2803163510"},"reference-count":56,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Injectable antiplatelet agents can provide immediate and effective platelet inhibition in patients with acute coronary syndromes (ACSs). These agents are able to overcome many of the limitations of oral antiplatelet agents, and may be of particular benefit in patients with ST-elevation myocardial infarction (STEMI), especially those presenting with cardiogenic shock (CS) or resuscitated cardiac arrest. In these patients, factors such as vomiting, altered physiology, sedation, mechanical ventilation, or therapeutic hypothermia can impair drug absorption, reducing the intended antiplatelet effect and increasing ischaemic risk. Intravenous aspirin is used widely in patients with ACS, while the absorption of oral P2Y12 inhibitors is often delayed, and the intravenous P2Y12 inhibitor cangrelor can achieve almost complete platelet inhibition within minutes. While the use of the glycoprotein IIb\/IIIa inhibitors (GPIs) eptifibatide and tirofiban is decreasing, typically reserved for thrombotic complications or no reflow following PCI, recently, zalunfiban, a novel subcutaneously administered GPI, has been shown to improve reperfusion before revascularization in patients with STEMI when given at first medical contact. In this review, we discuss the rationale and potential benefits of injectable antiplatelet medications, including currently available agents and those in development or being tested in clinical trials. While the benefit of injectable medications on hard clinical endpoints such as major adverse cardiac events remains unclear for an all-comers ACS population, there are emerging data that these agents achieve rapid platelet inhibition and improve coronary flow and clinical outcomes, particularly in high-risk ACS patients, such as those with CS.<\/jats:p>","DOI":"10.1093\/ehjacc\/zuag113","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T11:50:56Z","timestamp":1787226656000},"source":"Crossref","is-referenced-by-count":0,"title":["Injectable antiplatelet therapies in acute coronary syndromes: current status and emerging therapies"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7077-283X","authenticated-orcid":false,"given":"Uwe","family":"Zeymer","sequence":"first","affiliation":[{"name":"Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg , Hugstetter Strasse 51, 79106 Freiburg ,","place":["Germany"]},{"name":"Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University , Theodor-Kutzer-Ufer 1-3, 68167 Mannheim ,","place":["Germany"]},{"name":"Institut f\u00fcr Herzinfarktforschung , Bremserstrasse 79, Ludwigshafen 67063 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5046-487X","authenticated-orcid":false,"given":"Sogol","family":"Koolaji","sequence":"additional","affiliation":[{"name":"Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire , Hatfield, Hertfordshire ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3185-0051","authenticated-orcid":false,"given":"Diego","family":"Araiza-Garaygordobil","sequence":"additional","affiliation":[{"name":"Coronary Care Unit & Emergency Department, Instituto Nacional de Cardiolog\u00eda Ignacio Ch\u00e1vez , Ciudad de M\u00e9xico ,","place":["M\u00e9xico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Clemmensen","sequence":"additional","affiliation":[{"name":"University Heart and Vascular Center Hamburg (UHZ), Center for Population Health Innovation (POINT), University Clinic Hamburg-Eppendorf (UKE) , Hamburg ,","place":["Germany"]},{"name":"Department of Medicine-Cardiology, Zealand University Hospital , Nyk\u00f8bing F ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9709-6082","authenticated-orcid":false,"given":"Mario","family":"Gramegna","sequence":"additional","affiliation":[{"name":"Cardiac and Cardiac Surgery Intensive Care Unit, IRCCS San Raffaele Scientific Institute , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7792-2837","authenticated-orcid":false,"given":"Konstantin A","family":"Krychtiuk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II\u2014Division of Cardiology, Medical University of Vienna , Vienna ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3065-625X","authenticated-orcid":false,"given":"Christoph B","family":"Olivier","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg , Hugstetter Strasse 51, 79106 Freiburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8657-6235","authenticated-orcid":false,"given":"Andrea","family":"Rubboli","sequence":"additional","affiliation":[{"name":"Department of Emergency, Internal Medicine, and Cardiology, Division of Cardiology, S. Maria Delle Croci Hospital , Vienna ,","place":["Italy"]},{"name":"Faculty of Medicine, University of Bologna-Campus of Ravenna , Ravenna ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9041-3922","authenticated-orcid":false,"given":"Benedikt","family":"Schrage","sequence":"additional","affiliation":[{"name":"University Heart and Vascular Center Hamburg (UHZ), Center for Population Health Innovation (POINT), University Clinic Hamburg-Eppendorf (UKE) , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5151-6400","authenticated-orcid":false,"given":"Christophe","family":"Vandenbriele","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Cardiology and Critical Care, Royal Brompton & Harefield Hospitals, Guy\u2019s & St. Thomas\u2019 NHS Foundation Trust , London ,","place":["UK"]},{"name":"Cardiovascular Center, OLV Hospital Aalst , Aalst ,","place":["Belgium"]},{"name":"Faculty of Medicine, Imperial College , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1695-3378","authenticated-orcid":false,"given":"Kurt","family":"Huber","sequence":"additional","affiliation":[{"name":"Austrian Heart Foundation , Vienna ,","place":["Austria"]},{"name":"Medical Private University Burgenland (MPUB) , Pinkafeld\/Oberwart ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9286-1451","authenticated-orcid":false,"given":"Diana A","family":"Gorog","sequence":"additional","affiliation":[{"name":"Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire , Hatfield, Hertfordshire ,","place":["UK"]},{"name":"Faculty of Medicine, National Heart and Lung Institute, Imperial College , London ,","place":["UK"]},{"name":"School of 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