Triple antiplatelet treatment in patients presenting with non-ST-segment elevation acute coronary syndromes

Antiplatelet drugs are pivotat in the management of non-ST-segment elevation acute coronary syndrome (ACSs). The guidelines recommend dual antiplatelet treatment associating aspirin and clopidogrel as a first-line treatment. In high-risk patients (with recurrent ischaemia, ST-segment depression, elevated troponins, and diabetics, according to the European Society of Cardiology guidelines) and moderate-to-high-risk patients (as assessed by the TIMI risk score in the ACC/AHA guidelines), it is recommended to add a glycoprotein IIb/IIIa receptor inhibitor to the baseline treatment, i.e. triple antiplatelet treatment. However, this tatter strategy has not, until recently, been validated by proper, adequate randomized trials. This article considers the rationale and the evidence for triple antiplatelet treatment in high-risk patients presenting with non-ST-segment elevation ACSs.