Antithrombotic drugs

Consequently, the role of chronic aspirin administration in helping to prevent myocardial and cerebral infarction remains an area of intense investigation. There seems to be little doubt that aspirin can be a very cost-effective method for decreasing the morbid- 

Finally, aspirin has also been used to prevent thrombus formation in peripheral veins (deep vein thrombosis [DVT]), and aspirin is sometimes used as an adjunct or alternative to anticoagulants (heparin, warfarin) that are routinely used to treat DVTs.8 Aspirin can likewise be administered to prevent thromboembolism following surgical procedures such as coronary artery bypass, arterial grafts, endarterectomy, and valve replacement 45,78 By preventing platelet-induced thrombogenesis, aspirin helps maintain patency and prevent reocclusion of vessels following these procedures. 

Finally, sulfinpyrazone (Anturane) is usually administered to treat gouty arthritis, but has also shown some antithrombotic properties because of an ability to decrease platelet function. Sulfinpyrazone decreases platelet aggregation by inhibiting prostaglandin synthesis in a manner similar to aspirin. Sulfinpyrazone can be used as an alternative to aspirin in pre- 

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Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection. Cochrane... 

Identify factors that place a patient at high risk of bleeding while receiving antithrombotic drugs. 

Select and interpret laboratory test(s) to monitor antithrombotic drugs. 

Given that VTE can be debilitating or fatal, it is important to treat it quickly and aggressively.8 On the other hand, because major bleeding induced by antithrombotic drugs can be equally harmful, it is important to avoid treatment when the diagnosis is not reasonably certain. Assessment of the patient s status should focus on the search for risk factors in the patient s medical history... 

Elbayoumi TA, Torchilin VP (2008) Liposomes for targeted delivery of antithrombotic drugs. Expert Opin Drug Deliv 5 1185-1198... 

Contraindications are similar to those of other antithrombotic drugs, and hemorrhage is the most common and serious adverse effect. For all agents in this class, a CBC should be obtained at baseline and periodically thereafter to detect potential bleeding. There are no known agents that reverse the activity of direct thrombin inhibitors. 

Pd-catalyzed alkoxycarbonylation enables synthesis of a variety of heterocyclic esters that are otherwise not easily prepared. 5-Bromopyrimidine was transformed into 5-ethoxycarbonyl-pyrimidine in quantitative yield employing the Pd-catalyzed alkoxycarbonylation. The alkoxycarbonylation of 2-chloro-4,6-dimethoxypyrimidine, in turn, led to benzyl 4,6-dimethoxypyrimidine-2-carboxylate (112), whereas alkoxycarbonylation of 2-(chloromethyl)-4,6-dimethoxypyrimidine provided pyrimidinyl-2-acetate 113 [79]. 4,6-Dimethoxypyrimidines 112 and 113 are both important intermediates for the preparation of antihypertensive and antithrombotic drugs. 

Conley, P. B., Jantzen, H. M., Vincent, D., et al. (2000) Molecular identification of the platelet ADP receptor targeted by antithrombotic drugs. Blood. 96, 222A. 

J Fareed. Current trends in antithrombotic drug and device development. Sem Thromb Hemostas 22 3-8, 1996. 

Walenga JM, Hoppenstaedt DA. Monitoring the new antithrombotic drugs. Semin Thromb Hemost 2004 30 683-95. 

Editor s Note Tile following references have been selected to provide the interested reader wiLli more detail on the pharmacologic complexities of anticoagulants Tile article by Edwin W. Salzman, M.D. is a short, but excellent summary of the status of antithrombotic drugs as of early 1992. The article on heparin by Jack Hirsh, MD. and the article on warfarin by the same author proride important fundamental background information on the pharmacokinetics and pharmacodynamics of the most widely used anticoagulant drugs, Brandjes. D.P.M., et al. Acenocoumarol and Heparin Compared with Acenocoumarol. Alone in the Initial Treatment of Proximal-Vein Thrombosis," N. Eng. J. Med., 1485 (November 19, 1992). 

Schror K. Antithrombotic drugs in vascular medicine a historical perspective. Semin Vase Med. 2003 3 97-105. 

Thiagarajan P. New targets for antithrombotic drugs. AmJ Cardiovasc Drugs. 2002 2 227-235. 

Wu KK, Matijevic-Aleksic N. Molecular aspects of thrombosis and antithrombotic drugs. Crit Rev Clin Lab Sci. 2005 42 249-277. 

Hollopeter G, Jantzen HM, Vincent D et al (2001) Identification of the platelet ADP receptor targeted by antithrombotic drugs. Nature 409 202-7 Holton FA, Holton P (1953) The possibility that ATP is a transmitter at sensory nerve endings. J Physiol 119 50P—51P... 

See color plate.) Current anticoagulant and antithrombotic drugs encompass a wide variety of chemically and biologically-derived substances. 

Based on the differences between hemostasis and thrombosis mechanisms, which, even though similar, are developing through different routes, the practical point related to antithrombotic therapies is that increased concentrations of antithrombotic drugs will affect thrombosis as well as hemostasis but, as the latter is a weaker process than the former, any important increase in anticoagulant potential will produce a bleeding tendency before stopping thrombosis (26). 

Foster CJ, Prosser DM, Agans JM, et al. Molecular identification and characterization of the platelet ADP receptor targeted by thienopyridine antithrombotic drugs. J Clin Invest 2001 107 1591-1598. 

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