Clinical Trials of Novel Antithrombotics: Basic Concepts of Study Design and Methodology

  • Melvin E. Tan
  • Robert A. Harrington
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 193)


When the normally smooth endothelial surface of a blood vessel is denuded by the rupture of an atherosclerotic plaque or during the course of percutaneous coronary intervention, this triggers a cascade of events culminating in thrombus formation. Endothelial disruption leads to exposure of adhesive glycoproteins, such as collagen, von Willebrand factor (vWF), fibronectin, laminin, vitronectin, and subendothelial thrombospondin, to which circulating inactivated platelets adhere. This occurs largely through membrane glycoprotein (GP) Ib-factor IX binding to vWF immobilized onto subendothelial structures. These platelets are then activated by local agonists, which include epinephrine, adenosine diphosphate (ADP), collagen, serotonin, and thrombin. Platelet activation induces an active conformational change in the surface GPIIb/IIIa receptors; conferring on them a high affinity for fibrinogen, vWF, and other adhesive glycoproteins; and resulting in platelet aggregation and consequent thrombosis. This conformational change in the platelet GPIIb/IIIa receptor is believed to be the final common pathway by which all agonists act to initiate platelet aggregation.


Percutaneous Coronary Intervention Acute Myocardial Infarction Unstable Angina Platelet Glycoprotein Abciximab Bolus 
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Copyright information

© Kluwer Academic Publishers 1997

Authors and Affiliations

  • Melvin E. Tan
  • Robert A. Harrington

There are no affiliations available

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