Status of Clinical Trials Evaluating Eicosanoids in Atherosclerotic Vascular Disease and Thrombosis
The indications for the use of agents that modify eicosanoid metabolism in the management of patients with arterial vascular disease are limited despite extensive basic, experimental animal and clinical studies. Aspirin is clearly beneficial in men with transient ischemic attacks and patients with unstable angina. It is also anti-thrombotic when used in combination with oral anticoagulants in patients with artificial heart valves and in patients with arteriovenous cannulas undergoing he-modialysis (and manifest associated underlying platelet dysfunction). In general, the negative clinical trials have been uninformative because of uncertainty with respect to the role of eicosanoids in the pathogenesis of the outcome events, inadequately defined mechanisms of drug actions, and uncertainty regarding the effective doses for the drugs in the trials. In the absence of established mechanisms of drug action, dose regimens appear to require objective assays with thrombotic endpoints rather than the use of in vitro biochemical measurements of less certain interpretation.
KeywordsTransient Ischemic Attack Coronary Artery Spasm Graft Occlusion Artificial Heart Valve Saphenous Vein Bypass
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