Abstract
Anticoagulant therapies, which include antiplatelet and antithrombotic drugs, prevent and treat many cardiovascular disorders and are some of the most universally prescribed drugs. Rapid onset anticoagulant therapy is also required to perform a number of clinical procedures including percutaneous coronary interventions (PCI), structural heart interventions, cardiovascular surgery and other surgeries, as well as dialysis. This therapy is also used as a treatment for a number of thrombotic diseases including acute coronary syndromes (myocardial infarction and unstable angina), deep vein thrombosis, and pulmonary embolism.
When selecting the most appropriate anticoagulant drug, thorough consideration of the efficacy to safety ratio is warranted. In addition, there are a number of pharmacological factors that affect a drug’s success. This chapter focuses on the pharmacological properties of the most commonly used anticoagulants, antithrombotics, and antiplatelet drugs.
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References
Alquwaizani M, Buckley L, Adams C, Fanikos J. Anticoagulants: a review of the pharmacology, dosing, and complications. Curr Emerg Hosp Med Rep. 2013;1(2):83–97.
Franchi F, Angiolillo DJ. Novel antiplatelet agents in acute coronary syndrome. Nat Rev Cardiol. 2015;12(1):30–47.
Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med. 2010;35(1):64–101.
Douketis JD, Berger PB, Dunn AS, Jaffer AK, Spyropoulos AC, Becker RC, et al. The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest. 2008;133(6 Suppl):299S–339S.
Suggested Reading
Mega JL, Simon T. Pharmacology of antithrombotic drugs: an assessment of oral antiplatelet and anticoagulant treatments. Lancet. 2015;386(9990):281–91.
Mathiesen O, Wetterslev J, Kontinen VK, Pommergaard HC, Nikolajsen L, Rosenberg J, et al. Adverse effects of perioperative paracetamol, nsaids, glucocorticoids, gabapentinoids and their combinations: a topical review. Acta Anaesthesiol Scand. 2014;58(10):1182–98.
Awtry EH, Loscalzo J. Aspirin. Circulation. 2000;101(10):1206–18.
Büller HR, Davidson BL, Decousus H, Gallus A, Gent M, Piovella F, et al. Fondaparinux or enoxaparin for the initial treatment of symptomatic deep venous thrombosis: a randomized trial. Ann Intern Med. 2004;140(11):867–73.
Büller HR, Davidson BL, Decousus H, Gallus A, Gent M, Piovella F, et al. Subcutaneous fondaparinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism. N Engl J Med. 2003;349(18):1695–702.
Bussey HFJ, Heparin Consensus Group. Heparin overview and issues. Pharmacotherapy. 2004;24:103S–7S.
Carr JA, Silverman N. The heparin-protamine interaction. A review. J Cardiovasc Surg. 1999;40(5):659–66.
Di Nisio M, Middeldorp S, Buller HR. Direct thrombin inhibitors. N Engl J Med. 2005;353(10):1028–40.
Eriksson BI, Lassen MR, Investigators PEiH-FSP. Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2003;163(11):1337–42.
Garcia DA, Baglin TP, Weitz JI, Samama MM, American College of Chest P. Parenteral anticoagulants: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e24S–43S.
Greinacher A, Potzsch B, Amiral J, Dummel V, Eichner A, Mueller-Eckhardt C. Heparin-associated thrombocytopenia: isolation of the antibody and characterization of a multimolecular pf4-heparin complex as the major antigen. Thromb Haemost. 1994;71(2):247–51.
Gurbel PA, Myat A, Kubica J, Tantry US. State of the art: oral antiplatelet therapy. JRSM Cardiovasc Dis. 2016;5:2048004016652514.
Hamberg M, Svensson J, Samuelsson B. Thromboxanes: a new group of biologically active compounds derived from prostaglandin endoperoxides. Proc Natl Acad Sci U S A. 1975;72(8):2994–8.
Investigators C-O, Mehta SR, Bassand JP, Chrolavicius S, Diaz R, Eikelboom JW, et al. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. N Engl J Med. 2010;363(10):930–42.
Kambam J, Meszaros R, Merrill W, Stewart J, Smith BE, Bender H. Prophylactic administration of histamine1 and histamine2 receptor blockers in the prevention of protamine-related haemodynamic effects. Can J Anaesth. 1990;37(4 Pt 1):420–2.
Lehman CMFE. Laboratory monitoring of heparin therapy: Partial thromboplastin time or anti-xa assay? LabMedicine. 2009;40(1):47–51.
Levine MN, Raskob G, Landefeld S, Kearon C. Hemorrhagic complications of anticoagulant treatment. Chest. 2001;119(1 Suppl):108S–21S.
Levy JH, Zaidan JR, Faraj B. Prospective evaluation of risk of protamine reactions in patients with NPH insulin-dependent diabetes. Anesth Analg. 1986;65(7):739–42.
Loll PJ, Picot D, Garavito RM. The structural basis of aspirin activity inferred from the crystal structure of inactivated prostaglandin H2 synthase. Nat Struct Biol. 1995;2(8):637–43.
Love JE, Ferrell C, Chandler WL. Monitoring direct thrombin inhibitors with a plasma diluted thrombin time. Thromb Haemost. 2007;98(1):234–42.
Patrono C, Rocca B. Drug insight: aspirin resistance – fact or fashion? Nat Clin Pract Cardiovasc Med. 2007;4(1):42–50.
Schulman S, Beyth RJ, Kearon C, Levine MN, American College of Chest P. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American college of chest physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133(6 Suppl):257S–98S.
Selleng KWT, Greinacher A. Heparin-induced thrombocytopenia in intensive care patients. Crit Care Med. 2007;35:1165–76.
Thomas M, Shen KR. Coagulopathy and anticoagulation during thoracic surgery. Thorac Surg Clin. 2015;25(3):309–23.
Turpie AGGBK, Eriksson BI, et al. Fondaparinux vs enoxaparin for the prevention of venous thromboembolism in major orthopedic surgery. A meta-analysis of 4 randomized double-blind studies. Arch Intern Med. 2001;162:1833–40.
Weitz DS, Weitz JI. Update on heparin: what do we need to know? J Thromb Thrombolysis. 2010;29(2):199–207.
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Mackensen, G.B. (2018). Pharmacology of Anticoagulants, Antithrombotics, and Antiplatelet Drugs. In: Farag, E., Argalious, M., Tetzlaff, J.E., Sharma, D. (eds) Basic Sciences in Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-62067-1_14
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