Thrombosis And Hemostasis In Cardiology: Review Of Pathophysiology And Clinical Practice (Part Ii) - Recommendations For Antithrombotic Therapy

The adverse consequences of thrombosis are perhaps nowhere more evident than in clinical cardiology. Thrombosis and hemostasis are primary issues in the management of patients with atrial fibrillation, prosthetic heart valves, severe left ventricular dysfunction, and coronary artery disease. Clinical trials have defined a crucial role for anticoagulation with warfarin in patients with atrial fibrillation to reduce the incidence of stroke. Anticoagulation with warfarin and aspirin in combination offers significant protection from systemic emboli in patients with mechanical prosthetic valves, without a substantial increased risk of hemorrhage. The risk of systemic emboli may also be reduced by anticoagulation in patients with severe left ventricular dysfunction. Disturbance of the normal balance of hemostasis is a major factor in the pathophysiology of coronary artery disease. Antiplatelet therapy, antithrombin agents, anticoagulants, and fibrinolytic agents have been used to prevent and treat acute coronary thrombosis and to prevent reocclusion following thrombolysis and interventional therapy. Guidelines are presented for antithrombotic therapy in the practice of clinical cardiology.