Platelet inhibitors, anticoagulant therapy

Anticoagulant therapy, chiefly warfarin, and platelet inhibitors, such as aspirin, are used prophylactically to prevent thromboembolic disease while fibrinolytic drugs can be used to destroy thrombi already formed and can be life saving after a myocardial infarction or stroke. 

F. Role in therapy The potential advantages of Angiomax—a direct thrombin inhibitor—over heparin include activity against clot-bound thrombin, more predictable anticoagulation, and no inhibition by components of the platelet release reaction. The place in therapy of Angiomax will be determined by further comparisons with heparin, low-molecular weight heparins, and recombinant hirudin. 

There are a number of additional targets that may lead to effective antithrombotic therapy in ACS. In terms of anticoagulants, the concepts of agents that have dual inhibitor sites such as the one we find in heparin but that lack in some of its undesirable qualities could be very useful. The same concept may apply to drugs that have both anticoagulant and antiplatelet properties, It is quite probable that inhibitors of tissue factor as well as of the platelet ADP receptor when combined with aspirin might be very effective. An ability to block the feedback action of the polyphosphates released from platelets upon activation is also an attractive aim (Fig. 3),... 

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