ABC of antithrombotic therapy: An overview of antithrombotic therapy

doi:10.1136/bmj.325.7367.762

BMJ 2002;325:762-765 ( 5 October )

Clinical review

ABC of antithrombotic therapy

An overview of antithrombotic therapy

Andrew D Blann, Martin J Landray, Gregory Y H Lip.

The first 150 words of the full text of this article appear below.

Many of the common problems in clinical practice today relate to thrombosis. The underlying final pathophysiological processin myocardial infarction and stroke is thrombus formation (thrombogenesis).Common cardiovascular disorders such as atrial fibrillation andheart failure are also associated with thrombogenesis. Thrombosisis also a clinical problem in various cancers and after surgery,especially orthopaedic.

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Pathophysiology

Over 150 years ago Virchow recognised three prerequisites for thrombogenesis: abnormal blood flow, vessel wall abnormalities,and blood constituent abnormalities. This concept has been extendedby modern knowledge of the endothelial function, flow characteristics,and blood constituents including haemorheological factors, clottingfactors, and platelet physiology. As thrombus consists of plateletsand fibrin (and often bystanding erythrocytes) optimum antithromboticprophylactic therapy can and should be directed towardsboth.

Antiplatelet drugs

Aspirin and agents acting on the cyclo-oxygenase pathway
Aspirin irreversibly inhibits cyclo-oxygenaseby acetylation of amino acids that are next to the active site.In platelets, this is the . . . [Full text of this article]

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