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Can Recurrent Pregnancy Loss Be Prevented by Antithrombotic Agents?
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Audrey A. Merriam, Michael J. Paidas
Antithrombotic agents encompass two classes of drugs: antiplatelet agents (i.e., aspirin) and anticoagulant agents (i.e., heparin and low-molecular weight heparin [LMWH]). Antiplatelet agents prevent platelets from aggregating and forming blood clots. This class of drugs has recently gained popularity in obstetrics due to its ability to decrease the risk for preeclampsia in certain high-risk populations. Anticoagulant medications act by preventing fibrin formation, decreasing clot formation and growth. In addition, heparins have anti-inflammatory actions by inhibiting tumor necrosis factor (TNF)α production [1] and increasing TNF-binding protein [2].
Anticoagulation
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Louis M. Fink, Nicole A. Massoll, Alex A. Pappas
Appropriate anticoagulant dosage and administration regimens for specific anticoagulants are constantly being developed and revised. Therapies combining various anticoagulants and adjunct medication are undergoing clinical trials, and the use of anticoagulants with thrombolytic agents is now common (4). Anticoagulants are often used in clinical practice, and there has been an impetus to standardize the optimal laboratory monitoring for specific conditions and therapeutic effects. These consensus reports are published periodically by the American Society for Thoracic Medicine in the journal Chest (5). The appropriate cost-effective selection of anticoagulant therapy may have a significant effect on the morbidity and mortality of thrombotic disorders. For example, the use of low-molecular-weight heparins (LMWHs) in the treatment of venous thromboembolic (TE) disease may be undertaken without extensive laboratory monitoring in an outpatient setting. More effective prophylaxis with anticoagulation therapy during and after certain orthopedic procedures may decrease the total cost of postsurgical complications and extended or additional hospitalizations (6,7). Some of the newest antithrombotic agents are in experimental clinical trials and can only be used in limited therapeutic situations. The most common anticoagulant agents in use today are the various heparin preparations, including LMWHs, the oral anticoagulant warfarin, and antiplatelet agents such as aspirin or dipyridamole.
Vascular access for percutaneous interventionsand angiography
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Nay Htyte, Christopher J. White
Review of the patient’s anticoagulation status is as impor-tant as planning the procedure and choosing an optimalaccess site. Newer antithrombotic agents, like direct throm-bin inhibitors, present a challenge to the interventionalist asthey currently have no diagnostic testing to assess level ofanticoagulation. However, current recommendations sug-gest withholding these agents at least 3 days prior to anyelective major invasive procedure.
An update on novel therapies for treating patients with arterial thrombosis
Published in Expert Review of Hematology, 2023
Udaya S Tantry, Sanchit Duhan, Eliano Navarese, Bogumil Ramotowski, Parshotam Kundan, Kevin P Bliden, Paul Gurbel
It has been shown that the ‘thrombin pathway’ may play a pivotal role in the generation and propagation of thrombus in selected patients with arterial diseases. These patients may have hypercoagulability phenotype and can be treated with very low dose FXa inhibitor on top of standard DAPT. The latter concept may provide improved net clinical benefit with a lower risk for bleeding in patients with hypercoagulability. Finally, FXIa and FXIIa inhibition may provide additional antithrombotic effect with lower risk of bleeding. However, strong evidence from large scale clinical trials is needed before their implementation. These novel agents may provide more choices to overcome some of the unmet needs of current antithrombotic agents and provide better net clinical benefits in patients with arterial thrombosis.
Antiplatelet therapy for coronary artery disease in 2023: current status and future prospects
Published in Expert Review of Cardiovascular Therapy, 2023
Rishi Chandiramani, Alessandro Spirito, James W. Johnson, Adhya Mehta, Birgit Vogel, Robert T. Faillace, Roxana Mehran
Antithrombotic therapy remains the cornerstone for prevention and management of ischemic complications among patients with CAD. Over the last four decades, various antithrombotic agents and regimens have been investigated and implemented in clinical practice. Strategies to reduce ischemic risk broadly involve increasing the potency of P2Y12 inhibition and/or prolonging the duration of DAPT. On the other hand, an increased risk of bleeding can be managed by shortening DAPT duration, considering P2Y12 monotherapy or de-escalation of antiplatelet regimens. Individualized clinical judgment by incorporating tools to assess both the above ischemic and bleeding risks, while also taking patient preferences, comorbidities and barriers to care into account are crucial for determining the optimal approach in each clinical scenario.
Critical appraisal of evidence for anti-Xa monitoring and dosing of low-molecular-weight heparin in renal insufficiency
Published in Expert Review of Clinical Pharmacology, 2022
M. P. H. van den Broek, Marjon V. Verschueren, C. A. J. Knibbe
In conclusion, based on the review of these studies, the studies that support a therapeutic window for anti-Xa concentrations for venous diseases were performed in populations with arterial diseases who already were ‘at risk’ for the outcome because of the nature of their diseases. Moreover, in the ACS studies, patients also received other antithrombotic agents concomitantly, which even further increased their bleeding risk. Moreover, all the studies also have several statistical and methodological shortcomings, which means that it is unlikely to be able to correctly assume an unbiased clear association between anti-Xa concentrations and clinical outcome. This conclusion can be supported by the fact that other studies that were conducted with patients with venous diseases did not report any relationship between anti-Xa concentrations and clinical outcome [11–15].