[Current and future antithrombotic therapies]

In spite of progress, antithrombotic therapies involve the risk of haemorrhage. Thrombolytic agents have more or less fibrin specificity which is related to the risk of bleeding. These drugs have efficient antidotes which can be administered locally or by systemic route. The usual anticoagulants are vitamin K antagonists and heparin which have propensity to be given at reduced dose. Low molecular weight heparins have demonstrated good efficacy and tolerance in the prevention and treatment of venous thrombosis. New anticoagulants, specific inhibitors of activated factor X or thrombin, are now expected but they lack of specific antidotes. Platelet aggregation inhibitors, mainly aspirin, are widely used in the prevention of arterial thrombosis. New compounds particularly GPII/IIIa fibrinogen receptor antagonists have a broad spectrum but need to be used watchfully. Research underway suggest new molecules which will likely inhibit the procoagulant, phospholipid dependent, platelet activity or block thrombin receptor. Good knowledge of properties and progress in the preparation of improved haemostat agents could significantly reduce, particularly in dental surgery, the risk of haemorrhage.