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[Comment] GEMINI-ACS-1: toward unearthing the antithrombotic therapy cornerstone for acute coronary syndromes

The cornerstone of acute coronary syndrome therapy was firmly laid when ISIS-2 showed a 23% reduction in vascular death with aspirin versus placebo.1 The antithombotic effect of aspirin is largely explained by inhibition of COX 1, a central enzyme mediating platelet activation. This and pleotropic cardioprotective properties should be considered before forsaking or replacing aspirin, particularly early in the highly prothrombotic state of a new acute coronary syndrome (panel).2,3 The enhanced antithrombotic effect of combining aspirin with clopidogrel, an inhibitor of the P2Y12 receptor, another key pathway of platelet activation, revolutionised treatment of acute coronary syndromes.