Current perspectives in antithrombotic therapy

Summary

Thrombotic disorders are the most common cause of death in the United States. About two million individuals die each year from an arterial or venous thrombosis or related disorders. About 80% to 90% of all cases of thrombosis can now be defined with respect to cause. Of these, over 50% occur in patients who harbor a congenital or acquired blood coagulation protein or platelet defect which caused the thrombotic event. It is obviously of major importance to define those individuals harboring such a defect as this allows: 1) appropriate antithrombotic therapy to decrease risks of recurrence; 2) determination of the length of time the patient must remain on therapy for secondary prevention; and 3) allow for testing of family members of those harboring a blood coagulation protein or platelet defect which is hereditary (about 50% of all coagulation and platelet defects mentioned above). Aside from mortality, significant additional morbidity occurs from both arterial or venous thrombotic events, including, but not limited to paralysis (non-fatal thrombotic stroke), cardiac disability (repeated coronary events), loss of vision (retinal vascular thrombosis), fetal waste syndrome (placental vascular thrombosis), stasis ulcers and other manifestations of post-phlebitic syndrome, etc.

Zusammenfassung

Thrombotische Erkrankungen sind die häufigste Todesursache in den Vereinigten Staaten. Etwa zwei Millionen Personen sterben jährlich aufgrund einer arteriellen oder venösen Thrombose oder damit vergesellschafteter Störungen. Bei etwa 80 bis 90% aller Thrombosefälle kann mittlerweile die Ursache bestimmt werden. Über 50% dieser Fälle treten bei Patienten auf, die kongenitale oder erworbene Defekte der Blutgerinnungsfaktoren oder der Thrombozyten haben, durch die das thrombotische Ereignis verursacht wurde. Es ist sichtlich von großer Bedeutung, die Träger eines derartigen Defekts zu erkennen, denn dies ermöglicht: 1.) eine entsprechende antithrombotische Therapie zur Minderung des Rezidivrisikos; 2.) die Festlegung des Zeitraums, während dem der Patient die Therapie zur Sekundärprävention erhalten muss, und 3.) eine Untersuchung der Familienmitglieder von Trägern eines erblichen Defekts der Blutgerinnungsfaktoren oder der Thrombozyten (etwa 50% aller oben erwähnten Gerinnungs- und Thrombozytendefekte). Neben der Mortalität liegt auch eine signifikante zusätzliche Morbidität infolge sowohl arterieller als auch venöser thrombotischer Ereignisse vor, darunter unter anderem Lähmungen (nicht-tödlicher Schlaganfall), kardiale Störungen (wiederholte kardiale Ereignisse), Verlust der Sehfähigkeit (retinale Gefäßthrombose), Fetal-waste-Syndrom (plazentare Gefäßthrombose), Ulcera varicosi und andere Manifestationen des postthrombotischen Syndroms.

Keywords

Heparin - antithrombin agents - thrombolytics

Schlüsselwörter

Heparin - Antithrombine - Thrombolytika

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