Clinical pharmacology of antithrombotic drugs in coronary artery disease

Abstract

Coronary heart disease is the leading cause of death in the Western world. Antithrombotic therapy is the cornerstone of its successful treatment. Clinical trials have demonstrated that antithrombotic therapy reduces the risk for recurrent myocardial infarction and cardiovascular death. Antiplatelet drugs and anticoagulants interfere with haemostasis and thus bleeding is a major risk factor of these drugs. The benefit of antithrombotic therapy must therefore be carefully balanced with the risk of bleeding and other potential adverse reactions of these drugs. However, to date there is no firm evidence that dosage adaptation of aspirin or clopidogrel according to platelet aggregation testing translates directly into any clinical benefit. Resistance to antithrombotic drugs is a serious problem because these patients are at a higher risk of myocardial infarction, stroke and cardiovascular death. It has most recently been demonstrated that resistance to clopidogrel is at least in part caused by polymorphism of CYP2C19. Clinical trials have also demonstrated that optimal benefit in different settings depends unequivocally on the meticulous choice of the various drugs. Thus, profound knowledge of the clinical pharmacological profiles of the different antithrombotic drugs is indispensable for successful treatment.

Functional enhancement of platelet activation and aggregation by erythrocytes: role of red cells in thrombosis

“…29 Furthermore, ASA administration has been shown to reduce stroke and myocardial infarction severity. 30,31 However, individuals that experience recurrent thrombotic events while undergoing aspirin therapy may be classified as "aspirin resistant". ASA resistance is thought to be caused by the inability of ASA to exert inhibitory effects on platelet activation.…”

Evaluation of Clinical Pharmacy Services in Patients Receiving Antithrombotic Treatment: A Randomized Controlled Trial

“…In this case, antithrombotic therapy is important for the success of treatment. However, the widespread use of antithrombotic drugs suggests that patients receiving this treatment may be more vulnerable to DRPs 4 .…”

New players in the field of antiplatelet and anticoagulant therapy in coronary heart disease - current therapeutic issues and hot topics

“…In this issue of the journal, Fauler nicely reviews the clinical pharmacology of antithrombotic drugs in coronary artery disease [Fauler, 2009] with a focus on already established therapies. In the last decade, a variety of novel anticoagulant and antiplatelet agents that improve outcomes in patients undergoing percutaneous coronary revascularization has emerged.…”