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New approaches to inhibiting platelets and coagulation

Jeremiah P Depta1, Deepak L Bhatt

  • 1Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts 02115;

Annual Review of Pharmacology and Toxicology
|January 7, 2015
PubMed

Insights

This review covers evolving antiplatelet and anticoagulant therapies for preventing heart attack and stroke. It discusses traditional and novel agents, including aspirin, P2Y12 inhibitors, and direct oral anticoagulants, for managing thrombotic events.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Hematology

Background:

  • Ischemic heart disease and stroke are leading global causes of death and disability.
  • Thrombotic events stem from platelet activation and coagulation cascade, often linked to atherosclerosis.
  • Current therapeutic strategies involve antiplatelet and anticoagulant medications.

Purpose of the Study:

  • To review the pharmacology and clinical evidence of traditional and novel antiplatelet and anticoagulant therapies.
  • To discuss the evolving landscape of treatments for preventing thrombotic events.
  • To address controversies surrounding aspirin use and optimal dosing.

Main Methods:

  • Literature review of pharmacological data and clinical trial evidence.
  • Analysis of current and emerging antiplatelet agents, including P2Y12 inhibitors.
  • Evaluation of advancements in oral anticoagulation, such as direct thrombin and factor Xa inhibitors.

Main Results:

  • Aspirin's role in primary prevention remains debated, with ongoing discussion on secondary prevention doses.
  • New oral and intravenous P2Y12 inhibitors are transforming antiplatelet therapy.
  • Direct thrombin and factor Xa inhibitors offer effective oral anticoagulation without routine monitoring.

Conclusions:

  • The field of antiplatelet and anticoagulant therapy is rapidly advancing.
  • Novel agents provide new options for managing and preventing thrombotic cardiovascular and cerebrovascular events.
  • Evidence supports the expanding use of newer agents with improved safety and efficacy profiles.

Keywords:
acute coronary syndromeanticoagulationantiplateletantithrombotic therapyatherothrombosisvenous thromboembolism

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