Current Approaches to Antithrombotic Therapy
The pathophysiology of arterial thrombosis differs from that of venous thrombosis
Sylvia Haas, MDMany patients do not receive sufficient intervention to prevent and treat VTE. The reasons for this are unclear but may include a lack of awareness among clinicians of the true prevalence of VTE, which is often clinically silent.
Professor of Medicine and former Director of the Haemostasis and Thrombosis Research Group at the Institute for Experimental Oncology and Therapy Research, Technical University of Munich, Germany
Thrombosis can form at any point in the circulatory system: in the veins, in the arteries, and in the heart.
Venous thromboembolism (VTE) is the third-leading cause of cardiovascular death worldwide. VTE is the main cause of vascular illness in young adults, and the incidence of VTE rises with age.168
Acute arterial thrombosis is the leading cause of heart attacks and the leading cause of about 80% of strokes in the developed world. While the risk for coronary artery thrombosis is at least as high in women as in men, atrial thrombosis is less common in women.95
The difference between venous thrombosis and arterial thrombosis is reflected in current approaches to therapy. Inhibition of the coagulation cascade is the main focus of preventive treatments for venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation (AF). In arterial thrombosis, platelets are the main therapeutic target.95
Venous thromboembolism (VTE) is the third-leading cause of cardiovascular death worldwide. VTE is the main cause of vascular illness in young adults, and the incidence of VTE rises with age.168
Acute arterial thrombosis is the leading cause of heart attacks and the leading cause of about 80% of strokes in the developed world. While the risk for coronary artery thrombosis is at least as high in women as in men, atrial thrombosis is less common in women.95
The difference between venous thrombosis and arterial thrombosis is reflected in current approaches to therapy. Inhibition of the coagulation cascade is the main focus of preventive treatments for venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation (AF). In arterial thrombosis, platelets are the main therapeutic target.95
For patients undergoing certain surgical procedures or with specific medical illnesses there are challenges associated with selecting currently available preventive therapies, as greater efficacy may be associated with increased bleeding risks.3, 55, 69
For patients with established VTE, prompt diagnosis and treatment are critical to achieving symptom relief, prevention of the recurrence of deep vein thrombosis (DVT), prevention of pulmonary embolism (PE) and prevention of death.20
In the treatment of acute coronary syndrome (ACS), following revascularisation and initial antithrombotic management, secondary prevention with antithrombotic treatments is an important part of ongoing care.129
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Yahoo! My Web- 168 - Brenner B. State of the art thrombosis prevention and treatment. Therapy. 2008;5(2):123-124.
- 95 - Mackman N. Triggers, targets and treatments for thrombosis. Nature. 2008;451(7181):914-918.
- 3 - 1. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6)(suppl):381S-453S.
- 55 - Kakkar AK. Prevention of venous thromboembolism in general surgery.In: Colman RW, Marder VJ, Clowes AW, George JN, Goldhaber SZ, eds. Hemostasis and Thrombosis: Basic Principles and Clinical Practice. 5th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2006:1361-1367.
- 69 - Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA. Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med. 2007;146(4):278-288.
- 20 - Bates SM, Ginsberg JS. Clinical practice. Treatment of deep-vein thrombosis. N Engl J Med. 2004;351(3):268-277.
- 129 - Gelfand EV, Cannon CP. Acute Coronary Syndrome. In: Colman RW, Marder VJ, Clowes AW, George JN, Goldhaber SZ, eds. Hemostasis and Thrombosis: Basic Principles and Clinical Practice. 5th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2006:1387-1404.
- Coagulation cascade
- Series of reactions by which a small stimulus is amplified to produce rapid coagulation.
- Venous thromboembolism
- A condition in which a blood clot (thrombus) forms in a vein, which in some cases then breaks free and enters the circulation as an embolus, finally lodging in and completely obstructing a blood vessel, e.g., in lungs causing a PE. The term encompasses both DVT and PE.
- Acute coronary syndrome
- This is an umbrella term used to cover any group of clinical symptoms compatible with acute myocardial ischaemia (chest pain due to insufficient blood supply to the heart muscle that results from coronary artery disease). Acute coronary syndrome covers the spectrum of clinical conditions ranging from unstable angina to STEMI and NSTEMI.
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