CHEST Guidelines-New-Antithrombotic-Drugs

New-Antithrombotic-Drugs_chest

Pdf Summary

The document provides comprehensive insights into the 9th edition ACCP guidelines on antithrombotic therapy and prevention of thrombosis, focusing on new antithrombotic drugs. Thrombosis, a significant contributor to morbidity and mortality, encompasses arterial and venous forms — the former leading to myocardial infarction, ischemic stroke, and limb gangrene, and the latter encompassing deep vein thrombosis and pulmonary embolism. <br /><br />In arterial thrombi, formed under high shear conditions, platelets are predominant, thus arterial thrombogenesis prevention strategies focus largely on platelet function inhibitors along with anticoagulants for at-risk patients. Conversely, venous thrombi form under low shear conditions, consist mainly of fibrin, and are primarily managed with anticoagulants. Limitations of current drugs have driven the quest for new agents, reflected in ongoing research prominently focused on phase 2 and 3 trials.<br /><br />New antithrombotic drugs being scrutinized include novel antiplatelet, anticoagulant, and fibrinolytic drugs. Clinical advancement is noted primarily in antiplatelet drugs and anticoagulants, whereas new fibrinolytic developments lag. The document also discusses challenges with existing antiplatelet drugs, such as aspirin and clopidogrel, noting breakthrough cardiovascular events and efficacy limitations due to individual variability in drug response. It reviews the need for new agents like terutroban, inhibitors targeting thrombin receptors, and elder agents like cangrelor and ticagrelor. <br /><br />Rivaroxaban, a direct factor Xa inhibitor, and dabigatran etexilate, a direct thrombin inhibitor, both have been licensed in various countries, illustrating the shift towards novel oral anticoagulants. Emerging insights focus on the quest for anticoagulation alternatives to vitamin K antagonists, with oral agents taking precedence due to their fixed-dose administration and elimination of monitoring needs.<br /><br />Finally, the broader impact of antithrombotic advancements is assessed against unmet therapeutic needs, emphasizing customized treatment plans based on patient-specific factors and genetic profiles. The document underscores the complexities and nuanced advancements in antithrombotic therapies, outlining promising drugs and ongoing challenges in contemporary clinical applications.

Keywords

ACCP guidelines

antithrombotic therapy

thrombosis prevention

novel antithrombotic drugs

arterial thrombogenesis

venous thrombi

platelet function inhibitors

novel oral anticoagulants

rivaroxaban

dabigatran etexilate