Encyclopedia of Heart Diseases

2011 Edition
| Editors: M. Gabriel Khan

Anticoagulants

Reference work entry
DOI: https://doi.org/10.1007/978-1-60761-219-3_12

Overview

In approximately 90% of cases, the cause of a fatal or a nonfatal myocardial infarction (MI) or stroke is a blood clot in a coronary artery (coronary thrombosis) or cerebral artery (cerebral thrombosis). The clot often occurs on the surface of a plaque of  atheroma that is partially obstructing the lumen of the coronary artery. Patients may have many large atheromatous plaques and yet do not develop a clot over a 5–40-year period. There is no test that can tell us when and where a clot will occur.

Reduction in fatal and nonfatal heart attacks and other thrombotic events requires prevention and therapeutic strategies that include
  • Prevention of atheroma formation in arteries; prevention of erosion or rupture of atheromatous plaques in the coronary arteries and cerebral circulation. Plaque rupture liberates highly thrombogenic substances that rapidly cause clotting and blockage of arteries.

  • Clot-dissolving drugs (thrombolytic agents).

  • Agents that prevent clot formation ( anticoagulants...

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Bibliography

References

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Suggested Reading

  1. Becker RC (2005) Novel constructs for thrombin inhibition. Am Heart J 149:S61–S72PubMedGoogle Scholar
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Case Studies

  1. ASSENT-3 (2001) The ASSENT-3 randomized trial in acute myocardial infarction. Lancet 358:605–613. ASSENT-3Google Scholar
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  3. GUSTO Investigators (1993) An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 329:673. GUSTOGoogle Scholar
  4. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group (1988) Randomised trial of intravenous streptokinase, oral aspirin, both, or neither, among 17,187 cases of suspected acute myocardial infarction. Lancet 2:350. ISIS-2Google Scholar
  5. Lassen MR, Raskob GE, Gallus A et al (2010) Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. Lancet 375:807–815. PADVANCE-2 InvestigatorsPubMedGoogle Scholar
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  7. Stone GW, Witzenbichler B, Guagliumi G et al (2008) Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med 358(21):2218–2230. HORIZONS-AMI Trial InvestigatorsPubMedGoogle Scholar
  8. The Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators (2006) Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med 354:1464–1476. The OASIS-5Google Scholar
  9. The OASIS-6 Trial Group (2006) Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction. The randomized trial. JAMA 295:1519–1530. OASIS-6Google Scholar

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