The antithrombic drugs in clinical practice.

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Thrombosis Research

Background:

• Antithrombic drug use hinges on differentiating arterial (platelet-driven) and venous (fibrin-driven) thrombosis.
• Despite theoretical principles and diagnostic advances, practical application of antithrombic therapies lacks consensus.

Purpose of the Study:

• To review the rational use of antithrombic drugs based on thrombosis pathogenesis.
• To highlight discrepancies between theoretical guidelines and clinical practice for antithrombic drug selection.

Main Methods:

• Literature review of antithrombic drugs and their clinical evaluation.
• Analysis of drug efficacy in specific conditions like coronary artery disease, mitral valve disease, and cerebral/venous thrombo-embolism.

Main Results:

• Aspirin, dipyridamole, or sulphinpyrazone show benefit in secondary prevention of myocardial infarction, but differences are not statistically significant.
• Anticoagulants are effective for systemic thrombo-embolism in mitral valve disease; dipyridamole may be added for cardiac prostheses.
• Treatment for cerebral ischemia varies; stable patients may use aspirin alone, while those with recent deterioration benefit from anticoagulants plus aspirin.
• Heparin prophylaxis and risk factor reversal are recommended for venous thrombo-embolism; anticoagulation is preferred for acute events, potentially with thrombolytic therapy.

Conclusions:

• Clinical decisions on antithrombic drugs require consideration of drug interactions, monitoring feasibility, and patient compliance.
• Optimizing antithrombic therapy necessitates balancing theoretical benefits with practical patient management to avoid poor compliance and unpredictable responses.