• Mattia Galli, Italo Porto, Felicita Andreotti, Domenico D'Amario, Rocco Vergallo, Della Bona Roberta R Department of Cardiovascular Diseases, Policlinico Casilino, Rome, Italy., and Filippo Crea.
• Cardiovascular and Thoracic Diseases, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
• Int. J. Cardiol. 2019 Jan 15; 275: 39-45.

AbstractAnticoagulant therapy during the acute phase of non-ST elevation acute coronary syndromes (NSTE-ACS) is strongly recommended by current international guidelines. Evidence supporting the use of anticoagulant therapy in the early phase of NSTE-ACS however, is based on dated trials mostly performed in the nineties and recent randomised clinical trials (RCTs), performed during the last 15 years, clearly evidence a dichotomy in the investigation of antiplatelet and anticoagulant strategies. Many innovations have since occurred in the diagnosis and management of NSTE-ACS. Since a RCT evaluating the efficacy of anticoagulant therapy versus placebo in a contemporary setting of NSTE-ACS management is lacking, we provide a systematic review of 1) the randomised data for ATT in the early phase of NSTE-ACS; 2) modern international guidelines, and 3) contemporary clinical practice data. The results are analysed and potential treatment and research strategies are proposed.Copyright © 2018 Elsevier B.V. All rights reserved.

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