Los fármacos anticoagulantes y antiagregantes, junto con intervencionismo coronario, son la base del tratamiento del síndrome coronario sin elevación del segmento ST (SCASEST). Diferentes estudios han mostrado que la estrategia intervencionista con coronariografía y revascularización precoz es la que ofrece mejor resultado clínico en pacientes de alto riesgo. El tratamiento médico asociado puede modificar tanto el pronóstico de la enfermedad como el resultado de la revascularización coronaria. Hasta el momento, la aspirina, el clopidogrel y la heparina (no fraccionada o de bajo peso molecular) se consideran el tratamiento estándar en la mayor parte de los pacientes con SCASEST, y los inhibidores de los receptores de la glucoproteína IIb/IIIa, en los de alto riesgo, aunque persisten dudas acerca del resultado, el momento y la dosis de la asociación de clopidogrel y los inhibidores de la glucoproteína IIb/IIIa. Sin embargo, los buenos resultados clínicos demostrados por el fondaparinux respecto al uso de enoxaparina y la disminución de hemorragias observada con la bivalirudina en comparación con la asociación de heparina e inhibidores de la glucoproteína IIb/IIIa en 2 recientes estudios obligan a replantear el tratamiento actual de los SCASEST.
Palabras clave
Síndrome coronario agudo sin elevación del segmento ST
Antiagregantes
Anticoagulantes
Estrategia invasiva
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