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Abstract
There have been major advances in our understanding of thrombosis and antithrombotic drugs. This review focuses on the molecular aspects of thrombus formation and antithrombotic therapy. Molecules involved in arterial thrombosis are derived from inflammatory cells in the atherosclerotic plaque and blood platelets. These molecules work in concert to promote plaque instability and thrombogenicity. Thrombus formation on the ruptured plaque is mediated by platelet and coagulation activation. By contrast, molecules involved in venous thrombosis are derived from the activated coagulation cascade. Platelets appear to play a secondary role. The antithrombotic drugs are classified according to their targeted constituents: antiplatelet agents and anticoagulants; the latter are further divided into non-specific anticoagulants, such as vitamin K antagonists and heparin, and direct thrombin inhibitors, including hirudin and argatroban. Currently available antiplatelet agents target glycoprotein IIbIIIa (abciximab, tirofiban, eptifibatide), cyclooxygenase-1 (aspirin) or adenosine diphosphate receptor, P2Y12 (clopidogrel).
| Abbreviations | ||
| ADP | = | adenosine diphosphate |
| APC | = | activated protein C |
| aPTT | = | activated partial thromboplastin time |
| AT | = | antithrombin |
| CD40 | = | cell surface receptor |
| CD40L | = | CD40 ligand |
| CHD | = | coronary heart disease |
| COX-2 | = | cyclooxygenase-2 |
| DTI | = | direct thrombin inhibitor |
| DVT | = | deep vein thrombosis |
| eNOS | = | endothelial nitric oxide synthase |
| ER | = | endoplasmic reticulum |
| GPIb-IX-V | = | platelet glycoprotein Ib-IX-V complex |
| GPIIbIIIa | = | glycoprotein IIbIIIa |
| HCF2 | = | heparin cofactor 2 |
| HIT | = | heparin-induced thrombocytopenia |
| HITT | = | HIT with thrombosis |
| IL | = | interleukin |
| IP3 | = | inositide trisphosphate |
| LMWH | = | low molecular weight heparin |
| LPS | = | lipopolysaccharide |
| MMP | = | matrix metalloproteinase |
| mPGES | = | microsomal prostaglandin E synthase |
| NE | = | nuclear envelope |
| NO | = | nitric oxide |
| P2Y12 | = | ADP receptor |
| PAI-1 | = | plasminogen activator inhibitor-1 |
| PE | = | pulmonary embolism |
| PG | = | prostaglandin |
| PGIS | = | PGI2 synthase |
| PLA2 | = | phospholipase A2 |
| RGD | = | arginine-glycine-aspartic acid |
| TF | = | tissue factor |
| TFPI | = | tissue factor pathway inhibitor |
| TLR | = | Toll-like receptor |
| TM | = | thrombomodulin |
| TNF | = | tumor necrosis factor |
| tPA | = | tissue plasminogen activator |
| TXA2 | = | thromboxane A2 |
| TXAS | = | TXA2 synthase |
| UFH | = | unfractionated heparin |
| VTE | = | venous thromboembolism |
| vWF | = | von Willebrand factor |
| Abbreviations | ||
| ADP | = | adenosine diphosphate |
| APC | = | activated protein C |
| aPTT | = | activated partial thromboplastin time |
| AT | = | antithrombin |
| CD40 | = | cell surface receptor |
| CD40L | = | CD40 ligand |
| CHD | = | coronary heart disease |
| COX-2 | = | cyclooxygenase-2 |
| DTI | = | direct thrombin inhibitor |
| DVT | = | deep vein thrombosis |
| eNOS | = | endothelial nitric oxide synthase |
| ER | = | endoplasmic reticulum |
| GPIb-IX-V | = | platelet glycoprotein Ib-IX-V complex |
| GPIIbIIIa | = | glycoprotein IIbIIIa |
| HCF2 | = | heparin cofactor 2 |
| HIT | = | heparin-induced thrombocytopenia |
| HITT | = | HIT with thrombosis |
| IL | = | interleukin |
| IP3 | = | inositide trisphosphate |
| LMWH | = | low molecular weight heparin |
| LPS | = | lipopolysaccharide |
| MMP | = | matrix metalloproteinase |
| mPGES | = | microsomal prostaglandin E synthase |
| NE | = | nuclear envelope |
| NO | = | nitric oxide |
| P2Y12 | = | ADP receptor |
| PAI-1 | = | plasminogen activator inhibitor-1 |
| PE | = | pulmonary embolism |
| PG | = | prostaglandin |
| PGIS | = | PGI2 synthase |
| PLA2 | = | phospholipase A2 |
| RGD | = | arginine-glycine-aspartic acid |
| TF | = | tissue factor |
| TFPI | = | tissue factor pathway inhibitor |
| TLR | = | Toll-like receptor |
| TM | = | thrombomodulin |
| TNF | = | tumor necrosis factor |
| tPA | = | tissue plasminogen activator |
| TXA2 | = | thromboxane A2 |
| TXAS | = | TXA2 synthase |
| UFH | = | unfractionated heparin |
| VTE | = | venous thromboembolism |
| vWF | = | von Willebrand factor |