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Antithrombotic drugs: part II

A S Gallus, J Hirsh

    Drugs
    |January 1, 1976
    PubMed
    Summary

    Ancrod offers no advantage over heparin for thrombosis. Dextran shows conflicting evidence for antithrombotic effects, while platelet inhibitors and plasminogen activators have specific clinical roles, with plasminogen activators effective for recent emboli but carrying bleeding risks.

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    Area of Science:

    • Pharmacology and Therapeutics
    • Cardiovascular Medicine
    • Hematology

    Background:

    • Ancrod, a defibrinating agent, has limited clinical data suggesting no superiority to heparin.
    • Dextran, a glucose polymer, demonstrates antithrombotic effects in experimental models, but clinical evidence is conflicting.
    • Platelet function inhibitors and thrombolytic agents represent other therapeutic avenues for thromboembolic disorders.

    Purpose of the Study:

    • To review the clinical efficacy and limitations of various antithrombotic agents.
    • To evaluate the evidence for dextran, platelet inhibitors, and thrombolytic drugs in managing thromboembolic conditions.
    • To delineate the current and potential roles of these agents in clinical practice.

    Main Methods:

    • Review of controlled randomized studies and uncontrolled clinical trials.
    • Analysis of experimental models of thrombosis.
    • Evaluation of clinical data for aspirin, sulphinpyrazone, dipyridamole, hydroxychloroquine, clofibrate, streptokinase, and urokinase.

    Main Results:

    • Dextran can prevent postoperative venous thromboembolism but has contraindications (reduced cardiac reserve) and risks (allergic reactions).
    • Platelet function inhibitors show varied effectiveness, potentially more in arterial than venous disorders, with uncertain roles in cerebrovascular and coronary artery disease.
    • Plasminogen activators (streptokinase, urokinase) are effective in lysing recent venous and arterial thrombi/emboli, particularly major pulmonary emboli, but increase bleeding risk compared to heparin.

    Conclusions:

    • Ancrod is not clinically advantageous over heparin.
    • Dextran's clinical utility as an antithrombotic is limited by conflicting evidence and potential side effects.
    • Plasminogen activators are valuable for acute thromboembolic events but require careful risk-benefit assessment due to bleeding complications.

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