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[Thrombosis and its therapeutic targets]
1Service d'hématologie biologique, Hôpital Lariboisière, Paris.
Pathophysiological factors of thrombosis (flow, exposed surface and blood reactivity) explain when, how and why a thrombosis does develop. The same factors associated to the fibrinolytic capacity of the vessel wall explain the spontaneous evolution of the thrombosis. Among these factors, blood flow determines the relative participation of platelets and that of coagulation cascade. In arterial thrombosis, atherosclerotic plaque rupture is the triggering factor and platelets are the main actors in the thrombotic reaction: in consequence platelets are the main target and antiplatelet agents the main drugs to use for preventing atherothrombotic ischaemic events. In venous thrombosis, flow (stasis) is the main factor (with an additional role of blood coagulability and of venous wall lesion), and blood coagulation is the main contributor: anticoagulants are the logical option to prevent venous thromboembolic events. Thrombolytic agents can be used in arterial thrombosis only when a fibrin network completes and stabilizes the occluding platelet thrombosis (in myocardial infarction and not in unstable angina) and this has to be applied very early so that the physiological dethrombosis can still be possible.
Pathophysiological factors of thrombosis (flow, exposed surface and blood reactivity) explain when, how and why a thrombosis does develop. The same factors associated to the fibrinolytic capacity of the vessel wall explain the spontaneous evolution of the thrombosis. Among these factors, blood flow determines the relative participation of platelets and that of coagulation cascade. In arterial thrombosis, atherosclerotic plaque rupture is the triggering factor and platelets are the main actors in the thrombotic reaction: in consequence platelets are the main target and antiplatelet agents the main drugs to use for preventing atherothrombotic ischaemic events. In venous thrombosis, flow (stasis) is the main factor (with an additional role of blood coagulability and of venous wall lesion), and blood coagulation is the main contributor: anticoagulants are the logical option to prevent venous thromboembolic events. Thrombolytic agents can be used in arterial thrombosis only when a fibrin network completes and stabilizes the occluding platelet thrombosis (in myocardial infarction and not in unstable angina) and this has to be applied very early so that the physiological dethrombosis can still be possible.