From Heparin to Gpiib/Iiia Inhibitors and Doacs: The Revolution in Antithrombotic Therapy

Acute Coronary Syndrome (ACS) remains a significant global burden, necessitating ongoing innovation in therapeutic strategies. Over the past three decades, landmark clinical trials such as PRISM, PRISM-PLUS, PARAGON A, PARAGON B, PURSUIT, and GUSTO IV-ACS have shaped our understanding and management of ACS. These studies provided pivotal data on the role of antithrombotic agents, glycoprotein IIb/IIIa inhibitors, and tailored therapeutic approaches in high-risk populations. This review explores the design, outcomes, and impact of these foundational trials while tracing the evolution of ACS management to current guidelines and practices. Furthermore, we analyze how the insights from these trials have influenced contemporary clinical decision-making and identify the gaps they left for future research. By revisiting these landmark studies, we aim to contextualize their legacy and discuss their relevance in the era of precision medicine and novel therapeutic modalities.