By Shaker A. Mousa
1This selection of assessment articles highlights the newest improvement of antithrombotics and gives confirmed experimental equipment for the additional improvement of latest and superior anticoagulants. one of the state of the art advancements reviewed are the radical utilization of low molecular weight heparins, such antithrombin brokers because the hirudin, and such antiplatelet medicinal drugs because the GPIIb/IIIa inhibitors and ADP receptor antagonists. extra concepts mentioned comprise aspirin and clopidogrel, the improved use of polytherapeutic ways, antiproteases (factors IIa, Xa, and VIIa), tissue issue concentrating on, platelet receptor focusing on, and antithrombin III modulation.
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Additional info for Anticoagulants, Antiplatelets, and Thrombolytics (Methods in Molecular Medicine)
Subsequently, several other LMWHs such as ardeparin, tinzaparin, reviparin, and parnaparin were introduced. 5 billion dollars and expanded treatment plans reaching far beyond the initial indications for the prophylaxis of postsurgical DVT. CH04,35-48,14pgs 44 9/5/03 11:01 AM Page 44 Mousa Efficacy and safety comparisons of LMWHs vs UFH have demonstrated that LMWHs were at least as effective as UFH in reducing mortality rates after acute DVT. LMWHs were also shown to be as safe as UFH with respect to major bleeding complications, and as effective as UFH in preventing thromboembolic recurrences.
TFPI also interacts with several mechanisms, including elastase, protease generation, low-density lipoproteins, and tissue factor (TF) mediation of platelet and macrophage activation. TFPI is released into the bloodstream after administration of UFH or LMWHs, and prophylactic LMWH administra- CH04,35-48,14pgs 9/5/03 11:01 AM Page 43 Heparin and LMWH in Thrombosis 43 tion can increase TFPI plasma-concentrations (17,38). TFPI has demonstrated synergism with heparin in clotting assays, and may contribute to the antithrombotic effects of heparin (6).
3. Degree of Sulfation Chemical modifications of the end groups and internal structure, degree of sulfation, and charge density vary from product to product, and affect the characteristics of the products. Depending on the method of preparation, the LMWHs are different mixtures of various polysaccharides, antifactor X (anti-Xa), anti-IIa activities, endothelial TFPI release, and different biologic actions (6,16). CH04,35-48,14pgs 42 9/5/03 11:01 AM Page 42 Mousa 4. Plasmatic Effects Heparin affects the coagulation cascade at multiple sites.