Treatment Options
Antithrombotics
Antithrombotic agents are drugs with the overall objective of:
- Preventing thrombus formation: thromboprophylaxis
- Limiting thrombus extension and facilitating its dissolution: treatment of thrombosis
- Preventing thrombus recurrence: secondary prevention
There are three classes of antithrombotic drugs:
- Antiplatelet drugs inhibit platelet adhesion, platelet aggregation and/or platelet function
- Anticoagulant drugs interfere with one or several factors of the coagulation cascade and inhibit the transformation of fibrinogen into fibrin
- Thrombolytic drugs (also called fibrinolytic drugs) lyse pre-existing arterial or venous thrombi and rapidly restore the patency of the vessel.
A thrombus is composed of platelets, fibrin and erythrocytes:
- Arterial-type thrombi are platelet-rich
- Venous-type thrombi are fibrin
Antiplatelet drugs are more specifically indicated in the prevention and treatment of arterial thrombosis. They are generally not recommended for the prevention of venous thromboembolism.
Main antiplatelet drugs
- Aspirin
- Thienopyridines: ticlopidine (Ticlid®) and clopidogrel (Plavix®)
- Anti-GP IIb/IIIa: abciximab (Reopro®), tirofiban (Agrastat®), eptifibatide
(Integrilin®)
Anticoagulant drugs are indicated for both prevention and treatment of arterial and venous thrombosis
Main anticoagulant drugs
- Unfractionated heparin (UFH)
- Low-molecular-weight heparins (LMWH)
- Vitamin K antagonists (VKA)
- Fondaparinux (Arixtra®)
- Hirudin (Refludan®, Revasc®)
- Bivalirudin (Angiomax®)
Thrombolytic drugs are indicated in the treatment of both arterial and venous (pulmonary embolism) thrombosis
Main thrombolytic drugs
- Streptokinase
- Urokinase
- Recombinant tissue plasminogen activators
- Alteplase
- Reteplase
- Tenecteplase