title: General mechanisms of coagulation and targets of anticoagulants (Section I). Position Paper of the ESC Working Group on Thrombosis--Task Force on Anticoagulants in Heart Disease.
abstract: Contrary to previous models based on plasma, coagulation processes are currently believed to be mostly cell surface-based, including three overlapping phases: initiation, when tissue factor-expressing cells and microparticles are exposed to plasma; amplification, whereby small amounts of thrombin induce platelet activation and aggregation, and promote activation of factors (F)V, FVIII and FXI on platelet surfaces; and propagation, in which the Xase (tenase) and prothrombinase complexes are formed, producing a burst of thrombin and the cleavage of fibrinogen to fibrin. Thrombin exerts a number of additional biological actions, including platelet activation, amplification and self-inhibition of coagulation, clot stabilisation and anti-fibrinolysis, in processes occurring in the proximity of vessel injury, tightly regulated by a series of inhibitory mechanisms. "Classical" anticoagulants, including heparin and vitamin K antagonists, typically target multiple coagulation steps. A number of new anticoagulants, already developed or under development, target specific steps in the process, inhibiting a single coagulation factor or mimicking natural coagulation inhibitors.
authors: Institute of Cardiology, G. d'Annunzio University-- Chieti, Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy. rdecater@unich.it
authors: Raffaele
authors: R
authors: De Caterina
authors: Steen
authors: S
authors: Husted
authors: Lars
authors: L
authors: Wallentin
authors: Felicita
authors: F
authors: Andreotti
authors: Harald
authors: H
authors: Arnesen
authors: Fedor
authors: F
authors: Bachmann
authors: Colin
authors: C
authors: Baigent
authors: Kurt
authors: K
authors: Huber
authors: Jørgen
authors: J
authors: Jespersen
authors: Steen Dalby
authors: SD
authors: Kristensen
authors: Gregory Y H
authors: GY
authors: Lip
authors: João
authors: J
authors: Morais
authors: Lars Hvilsted
authors: LH
authors: Rasmussen
authors: Agneta
authors: A
authors: Siegbahn
authors: Freek W A
authors: FW
authors: Verheugt
authors: Jeffrey I
authors: JI
authors: Weitz
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D019983:Guideline Adherence / Q000592:standards; D006331:Heart Diseases / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000592:standards; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants