The use of secondary prevention measures, including dual antiplatelet therapy, has reduced the rate of myocardial infarction (MI), stroke and death from cardiovascular causes. However, there is also a rationale for combining antiplatelets and anticoagulants in the secondary prevention of acute coronary syndrome (ACS). Newer oral anticoagulants have been studied for secondary prevention of ACS and of these, a low-dose regimen of rivaroxaban was the only one to show a positive benefit–risk profile.
The incidence of stroke in patients with atrial fibrillation (AF) is 2-17 times greater than in the general population, dependent on the cause of AF. In addition, cardioembolic stroke is one of the most common complications of AF. The risk of stroke in patients with AF is also dependent on age, with older patients being at higher risk. Several risk assessment tools are available to clinicians to help estimate the risk of stroke. One well-validated and widely-used tool is the CHA2DS2-VASc score, which identifies both major risk factors and clinically relevant non-major risk factors.
What Could happen in the next 37 seconds?
Blood clots are the cause of the top three cardiovascular killers: heart attack, stroke and venous thromboembolism (VTE)
however, most blood clots can be prevented or if need be treated.
Go to http://www.worldthrombosisday.org to learn the symptoms and risk factors and if you are at risk, talk to your doctor.
Deep vein thrombosis (DVT) is usually the formation of a thrombus in the deep veins of the leg, although DVT may also occur in the veins of the upper extremities. DVT can occur spontaneously without a known underlying cause or after provoking events, such as trauma, surgery or acute illness. Complications of DVT include pulmonary embolism (PE), post-thrombotic syndrome (PTS) and a risk of VTE recurrence. The Wells score, a commonly used clinical score, quantifies the likelihood of an individual patient having DVT. Although a high Wells score indicates a clinical probability of DVT, an objective imaging technique, such as compression ultrasonography, must be used to confirm or rule out DVT.
Haemostasis is necessary for survival, but the pathological formation of a thrombus poses significant health risks. A pathological thrombus, formed when there is an imbalance in the blood coagulation system, can potentially obstruct blood flow, leading to a number of serious health conditions. Two different types of thrombi can be formed: arterial thrombi and venous thrombi. The pathologist Rudolph Virchow postulated that thrombus formation and propagation resulted from abnormalities in three areas, collectively known as Virchow’s Triad. Clinicians can now quantify some of these factors that, when abnormal, are associated with an increased risk of venous thromboembolism (VTE) and other cardiovascular diseases and of stroke in patients with atrial fibrillation (AF).
When a thrombus forms within an artery, this is known as an arterial thrombosis. Arterial thrombi manifest as Myocardial Infarction (MI), unstable angina, ischaemic stroke and some manifestations of peripheral arterial disease, such as acute limb ischaemia. Risk factors for arterial thrombosis include smoking; obesity; high blood pressure; increasing age; and family history. The incidence and prevalence of the clinical manifestations of arterial thrombosis is high. The annual incidence of MI and stroke in the US in 2008 has been calculated to be 935,000 and 795,000, respectively.
Two types of heparins are commonly used as anticoagulants - unfractionated heparin (UFH) and low-molecular-weight heparins (LMWHs). UFH has been used for the prevention and treatment of thrombosis for several decades. UFHs have variable anticoagulant effect and pharmacological properties and also have limited bioavailability and highly variable anticoagulant response. LMWHs are derived from UFH by depolymerization. Each LMWH product has a specific molecular weight distribution that determines its anticoagulant activity and duration of action. LMWHs are associated with a predictable dose response and fewer non-haemorrhagic side-effects. Because of several clinical advantages, LMWHs have gradually replaced UFH for most indications.
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