New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application

• Other Authors: Cimmino, Giovanni (Editor), Cirillo, Plinio (Editor)
• Format: Electronic Book Chapter
• Language: English
• Published: Basel MDPI - Multidisciplinary Digital Publishing Institute 2023
• Subjects: Medicine; Clinical & internal medicine; P2Y12 inhibitor; monotherapy; percutaneous coronary intervention; dual antiplatelet therapy; high bleeding risk; high on-treatment platelet reactivity; randomized controlled trial; left atrial appendage thrombus; atrial fibrillation; stroke; oral anticoagulant; cardiovascular diseases; novel antithrombotic agents; antiplatelet drugs; anticoagulants; hemostasis; factor XI; factor XI inhibitor; thrombosis; new drugs; left ventricular thrombus; anticoagulation; anterior wall myocardial infarction; dual therapy; direct oral anticoagulants; surface plasmon resonance; metformin; matrix metalloproteinase-9; plaque instability; atherosclerosis; cancer; acute coronary syndrome (ACS); percutaneous coronary intervention (PCI); dual antiplatelet therapy (DAPT); triple antithrombotic therapy (TAT); atrial fibrillation (AF); cardiotoxicity; aspirin; coronary artery disease; cerebrovascular disease; diabetes mellitus; essential thrombocythemia; platelet function; thromboxane; gastrointestinal bleeding; enteric-coated aspirin; cardiovascular prevention; P2Y12 inhibitors; acute coronary syndrome; clopidogrel; prasugrel; ticagrelor; cangrelor; selatogrel; zalunfiban; peripheral artery disease (PAD); antithrombotic therapy; dual pathway inhibition (DPI); major adverse cardiovascular events (MACE); major adverse limb events (MALE); n/a
• Online Access: DOAB: download the publication; DOAB: description of the publication

Thrombosis is a pathophysiological phenomenon observed in acute and chronic coronary syndrome, stroke, and peripheral artery disease. Exposure of the Tissue Factor (TF) to flowing blood is followed to its binding to other coagulation factors leading to thrombin formation. Together with platelet activation, TF ultimately promotes thrombus formation. Recent advances in platelet pathophysiology have shown that these cells are able to regulate their gene/protein expression, engage in de novo protein synthesis, and release different mediators that may interfere with different cell functions. Several clinical trials have clearly shown the efficacy of anticoagulation and/or anti-platelet aggregation in different thrombotic disorders. Real-world practice clearly indicates that antithrombotic strategies need to be personalized according to patient characteristics. The combination of multiple antithrombotic drugs represents a challenging scenario and was the focus of multiple recent randomized controlled trials, with more still to come. As knowledge about platelets and the coagulation system has substantially evolved within the last few years, so should our approach to antithrombotic treatment; focused on current hurdles of antithrombotic treatments in patients with cardio- and cerebrovascular diseases, starting from the molecular mechanisms involved, proposing practical solutions to compelling clinical scenarios using a pathophysiology-oriented approach on the basis of current clinical evidence.