Basics of Antiplatelet and Anticoagulant Therapy for Cardiovascular Disease

Summary Atherosclerotic cardiovascular disease comprises coronary artery disease (CAD), cerebrovascular disease, and peripheral artery disease (PAD). The arterial thrombosis comprises three basic pathways: platelet adhesion, activation, and aggregation; blood coagulation with fibrin formation; and fibrinolysis. This chapter reviews the pathophysiology of the arterial thrombosis cascade and provides a general overview of current and novel antiplatelet and anticoagulant agents. Platelet activation and aggregation in the extension phase can be induced by multiple pathways. Aspirin (ASA) permanently inactivate platelet COX-1, blocking the production of TXA2. Cilostazol is indicated for symptomatic relief of intermittent claudication from PAD and does not have an indication for treatment of patients with CAD although it has been studied extensively in adjunct to aspirin and clopidogrel. PAR-1 inhibitors block the binding of thrombin to PAR-1, thus inhibiting thrombin-induced platelet activation and aggregation. Indirect thrombin inhibitors include unfractionated heparin (UFH) and low molecular weight heparins (LMWH).