Pharmacological Management of Thrombosis: Current State and Future Strategies

Thromboembolic disorders remain a primary cause of mortality globally, with their burden expected to increase due to an aging population. While various antithrombotic agents exist, many patients still rely on traditional gold-standard drugs like heparin, warfarin, and aspirin, which present significant drawbacks. These include the need for injections, frequent monitoring, dietary restrictions, drug interactions, bleeding complications, or other adverse reactions such as thrombocytopenia. In contrast, direct oral anticoagulants offer advantages over warfarin, including fewer interactions and less need for continuous monitoring. However, even with newer drugs, patients face risks of major bleeding events. Current research focuses on novel antithrombotic agents with superior efficacy and enhanced safety compared to existing treatments. Researchers are exploring specific clinical niches, such as factor XI/XII inhibitors for cancer patients, to facilitate evaluation against standard treatments. The development of new antiplatelet drugs, like subcutaneous zalunfiban and selatogrel for pre-hospital therapy of myocardial infarction, and specific reversal agents, such as bentracimab for ticagrelor, exemplify this trend. Future research will likely focus on addressing the unmet needs of specific patient groups. This narrative review aimed to describe the current antithrombotic treatment and the most promising advances in the pharmacological management of thrombosis.