Causation and Prevention of Coronary Thrombosis : Present Situation
Most coronary thrombi large enough to be detected by angiography are associated with tears or fissures in the caps of atherosclerotic plaques. These fissures allow blood to penetrate into the arterial wall, whereupon thrombus forms within the intima; this may be followed by thrombosis in the lumen. This process was first described in 1926 (Benson, 1926; Constantinides, 1966); however, its pre-eminence in initiating acute clinical events was realized more recently after the microanatomy of coronary thrombi was established by serial histological sectioning (Fulton,1965; Davies and Thomas, 1981, 1985). Knowledge of post-mortem angiographic appearance of plaque fissures allowed them to be recognized in the angiograms of living patients with unstable angina (Ambrose, 1985, 1988; Lo et al., 1988) or with acute myocardial infarction, (Ambrose et al., 1985, 1986) and in patients resuscitated from sudden ischemic death. Angioscopy in living patients with unstable angina has also confirmed the presence of mural thrombi on torn atherosclerotic plaques in the coronary arteries (Sherman et al., 1986; Forrester et al., 1987).
KeywordsPlacebo Foam Aspirin Warfarin Resi
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- Benson RL. (1926). The present status of coronary arterial disease. Arch Pathol; 2: 870–916Google Scholar
- Fulton WFM. (1965). The coronary arteries: arterography microanatomy and pathogenesis of obliterative coronary disease. Spring field, illinois: Charles C. Thomas, 230–296Google Scholar
- ISIS-2 Second International Study of Infarct Survival Collaborative Group (Lancet 1988 ). Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction: ISIS 2. ii: 349–60Google Scholar
- Keeney SM, Richardsonb PD. (1987). Stress analysis of atherosclerotic arteries. Proceedings of the Ninth Annual Conference, Engineering in Medicine and Biology Soc. Inst Elec Electronic Engrs; 3: 1484–1485Google Scholar
- Mitchinson MJ, Ball RY. (Lancet 1987 ). Macrophages and atherogenesis. ii: 146–148Google Scholar
- Peto, R, Gray, R., Collins R., et al. (1988). A randomized trial of the effects of prophylactic aspirin among male British doctors. Br. Med. J. 196: 313-316 Google Scholar
- Richardson, P.D., Davies, M.J. and Born, G.V.R. (Lancet 1989 ). The role of plaque configuration and stress distribution in the pathogenesis of fissuring in human coronary atherosclerotic plaque. ii: 941–944Google Scholar
- Steering Committee of Physicians Health Study Research Group (1988). Preliminary report: findings from the aspirin component of the ongoing physicians health study. New Engl. J. Med. 318: 262–4 Google Scholar