Antiplatelets, Anticoagulants, and Fibrinolytics

Abstract

Primary hemostasis, secondary hemostasis, and fibrinolysis (anticoagulant biological system) are the three distinct-yet-interlinked components of the in vivo hemostatic mechanism. The primary hemostasis is characterized by platelet response resulting in the formation of a ‘temporary/soft’ hemostatic plug and the secondary hemostasis is the incitement of the coagulation cascade ultimately transforming the clot to a ‘definitive/hard’ hemostatic plug. Antiplatelets, anticoagulants, and fibrinolytics are drugs that aid in maintaining this intricate biological process of hemostasis by preventing either excessive pathological thrombus formation or excessive pathological bleeding. The chapter includes discussion on the various antiplatelet drugs—including, aspirin, clopidogrel, prasugrel, ticagrelor, cangrelor, abciximab, eptifibatide, tirofiban, vorapaxar, dipyridamole, and cilostazol; the anticoagulant drugs—including, heparins, fondaparinux, warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban; and the fibrinolytic drugs—including, streptokinase, alteplase, reteplase, and tenecteplase. The approved therapeutic application with the dosing guidelines for these drugs is also elucidated.