title: New approaches to inhibiting platelets and coagulation.
abstract: Ischemic heart disease and stroke are major causes of death and morbidity worldwide. Coronary and cerebrovascular events are a consequence of thrombus formation caused by atherosclerotic plaque rupture or embolism, both of which result from platelet activation and aggregation and thrombin-mediated fibrin generation via the coagulation cascade. Current and emerging antiplatelet and anticoagulant agents are evolving rapidly. The use of aspirin for primary prevention continues to be controversial, as are the doses appropriate for secondary prevention. Development of new oral and intravenous adenosine diphosphate P2Y12 inhibitors and novel antiplatelet agents continues to transform the landscape of antiplatelet therapy. Oral anticoagulation has advanced with the use of direct thrombin and factor Xa inhibitors that do not require therapeutic monitoring. In this review, we discuss the pharmacology and growing clinical evidence for traditional and new antiplatelet and anticoagulant therapies.
authors.affiliation: Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts 02115; email: dlbhattmd@post.harvard.edu.
authors.forename: Jeremiah P
authors.initials: JP
authors.lastname: Depta
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects; D002561:Cerebrovascular Disorders / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D003327:Coronary Disease / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D015195:Drug Design; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D058990:Molecular Targeted Therapy; D018579:Patient Selection; D015539:Platelet Activation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011322:Primary Prevention / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D015398:Signal Transduction / Q000187:drug effects; D013927:Thrombosis / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: acute coronary syndrome; anticoagulation; antiplatelet; antithrombotic therapy; atherothrombosis; venous thromboembolism