RT Book, Section
A1 Lichtman, Marshall A.
A1 Kaushansky, Kenneth
A1 Prchal, Josef T.
A1 Levi, Marcel M.
A1 Burns, Linda J.
A1 Linch, David C.
SR Print(0)
ID 1189336754
T1 Principles of Antithrombotic and Antifibrinolytic Therapy
T2 Williams Manual of Hematology, 10e
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264269204
LK hemonc.mhmedical.com/content.aspx?aid=1189336754
RD 2024/04/18
AB Antithrombotic  agents  are  characterized  separately  as  anticoagulants  (including  vitamin  K  antagonists,  heparin  or  heparin  derivatives,  and  directly  acting  thrombin  or  factor  Xa  inhibitors),  antiplatelet  agents,  or  fibrinolytic  drugs  (see  Chap.  87),  depending  on  their  primary  mechanism,  although  there  is  overlap  in  their  activities.  Table  88–1  provides  an  overview  of  the  types  of  the  most  frequently  used  anticoagulant,  antiplatelet,  and  fibrinolytic  agents.Anticoagulant  therapy  acts  to  decrease  fibrin  formation  by  inhibiting  the  formation  and  action  of  thrombin.  Its  most  common  use  is  in  preventing  systemic  embolization  in  patients  with  atrial  fibrillation,  treatment  of  acute  arterial  thrombosis  (eg,  myocardial  infarction  or  peripheral  arterial  thrombosis),  and  treatment  or  (secondary)  prevention  of  venous  thromboembolism.Anticoagulant  therapy  is  often  monitored  using  coagulation  testing  because  of  marked  biologic  variation  in  effect.Antiplatelet  agents  act  to  inhibit  platelet  function,  and  their  primary  uses  are  in  preventing  thrombotic  complications  of  cerebrovascular  and  coronary  artery  disease.  They  also  have  a  role  in  treatment  of  acute  myocardial  infarction.  They  have  no  effect  in  preventing  or  treating  venous  thromboembolism.For  many  agents,  the  risk-to-benefit  ratio  is  narrow,  with  the  result  that  bleeding  complications  occur.Bleeding  is  the  most  common  adverse  effect  of  anticoagulation  (Table  88–2).  Consequently,  the  clinician  should  carefully  weigh  the  risks  and  benefits  for  each  patient  when  selecting  treatment.The  most  common  oral  anticoagulants  are  vitamin  K  antagonists  (coumarins).  However,  new  oral  anticoagulants  with  specific  antithrombin  activity  or  anti–factor  Xa  activity  have  become  available  and  are  currently  increasingly  used  (see  section,  “Oral  Antithrombin  and  Anti–Factor  Xa  Agents”  below).