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Terapia antitrombótica y progresión de la enfermedad de las arterias coronarias. Las antiplaquetas frente a las
J H Chesebro1, M W Webster, P Zoldhelyi
1Divisions of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
Circulation
|December 1, 1992
Resumen
La trombina juega un papel clave en la trombosis arterial y la progresión de la enfermedad de las arterias coronarias. Las nuevas antitrombinas pueden prevenir la trombosis mural, pero su uso crónico y su impacto en la progresión de la enfermedad requieren más estudios.
Área de la Ciencia:
- Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
- Hematología Hematología.
- Farmacología Farmacología.
Sus antecedentes:
- La enfermedad de las arterias coronarias (CAD) progresa durante décadas, con acumulación de lípidos, alteración de la placa y trombosis.
- La trombosis arterial, particularmente la formación de trombos murales, es un evento crítico en la EAC.
- La trombina es un mediador central en la trombosis arterial, especialmente después de una lesión vascular profunda.
Objetivo del estudio:
- Para aclarar el papel fundamental de la trombina en la trombosis arterial.
- Discutir las limitaciones de las terapias antitrombóticas convencionales para prevenir la progresión de la ECA.
- Explorar el potencial de las nuevas antitrombinas para prevenir y tratar la trombosis mural en CAD.
Principales métodos:
- Revisión de la literatura existente sobre el papel de la trombina en la trombosis arterial y la EAC.
- Análisis de la eficacia de la inhibición específica de la trombina (por ejemplo, hirudina) en la prevención del trombo mural.
- Comparación de las terapias antitrombóticas convencionales (por ejemplo, aspirina) con los inhibidores específicos de la trombina.
Principales resultados:
- La inhibición específica de la trombina puede prevenir por completo el trombo mural intraluminal in vivo.
- Las trombas ricas en plaquetas de la lesión arterial profunda requieren niveles significativamente más altos de inhibición de la trombina.
- Las terapias antitrombóticas convencionales reducen los eventos clínicos, pero no detienen la progresión de la ECA.
Conclusiones:
- La trombina es esencial en la trombosis arterial, impulsando la progresión de la EAC.
- Las terapias antitrombóticas actuales son insuficientes para prevenir el trombo mural en lesiones arteriales profundas.
- Se necesita el desarrollo de antitrombinas crónicas disponibles por vía oral sin alto riesgo de hemorragia para reducir la progresión de la ECA.
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