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Titolo:
Anticoagulation: The present and future
Autore:
Van Aken, H; Bode, C; Darius, H; Diehm, C; Encke, M; Gulba, DC; Haas, S; Hacke, W; Puhl, W; Quante, M; Riess, H; Scharf, R; Schellong, S; Schror, K; Schulte, KL; Tebbe, U;
Indirizzi:
Univ Munster, Klin & Poliklin Anasthesiol, D-4400 Munster, Germany Univ Munster Munster Germany D-4400 Anasthesiol, D-4400 Munster, Germany Univ Freiburg Klinikum, Abt Kardiol, Freiburg, Germany Univ Freiburg Klinikum Freiburg Germany Abt Kardiol, Freiburg, Germany Univ Mainz Klinikum, Med Klin 2, Mainz, Germany Univ Mainz Klinikum Mainz Germany Klinikum, Med Klin 2, Mainz, Germany Klinikum Karlsbad, Innere Med Abt, Karlsbad, Germany Klinikum Karlsbad Karlsbad Germany d, Innere Med Abt, Karlsbad, Germany Univ Frankfurt Klinikum, Klin Allgemein & Gefasschirurg, D-6000 Frankfurt,Germany Univ Frankfurt Klinikum Frankfurt Germany D-6000 -6000 Frankfurt,Germany Krankenhaus Duren GmbH, Med Klin 1, Duren, Germany Krankenhaus Duren GmbHDuren Germany n GmbH, Med Klin 1, Duren, Germany Univ Klinikum Heidelberg, Neurol Klin, Heidelberg, Germany Univ Klinikum Heidelberg Heidelberg Germany l Klin, Heidelberg, Germany Klinikum Karlsbad, Innere Med Abt, Karlsbad, Germany Klinikum Karlsbad Karlsbad Germany d, Innere Med Abt, Karlsbad, Germany AK Hamburg Barmbeck, Abt Orthopad, Hamburg, Germany AK Hamburg Barmbeck Hamburg Germany eck, Abt Orthopad, Hamburg, Germany Humboldt Univ, Fak Med, Med Klin, D-1086 Berlin, Germany Humboldt Univ Berlin Germany D-1086 ed, Med Klin, D-1086 Berlin, Germany Univ Dusseldorf, Inst Hamostaseol, D-4000 Dusseldorf, Germany Univ Dusseldorf Dusseldorf Germany D-4000 ol, D-4000 Dusseldorf, Germany Univ Klinikum Dresden, Arbeitsbereich angiol, Med Klin 3, Dresden, GermanyUniv Klinikum Dresden Dresden Germany iol, Med Klin 3, Dresden, Germany Univ Dusseldorf, Inst Pharmakol, D-4000 Dusseldorf, Germany Univ Dusseldorf Dusseldorf Germany D-4000 ol, D-4000 Dusseldorf, Germany Ev Krankenhaus Konigin Elisabeth, Gefasszentrum Berlin, Med Klin, Berlin, Germany Ev Krankenhaus Konigin Elisabeth Berlin Germany d Klin, Berlin, Germany Klinikum Lippe Detmold, Med Klin 2, Detmold, Germany Klinikum Lippe Detmold Detmold Germany ld, Med Klin 2, Detmold, Germany Tech Univ Munich, Inst Expt Onkol, D-81675 Munich, Germany Tech Univ Munich Munich Germany D-81675 t Onkol, D-81675 Munich, Germany
Titolo Testata:
CLINICAL AND APPLIED THROMBOSIS-HEMOSTASIS
fascicolo: 3, volume: 7, anno: 2001,
pagine: 195 - 204
SICI:
1076-0296(200107)7:3<195:ATPAF>2.0.ZU;2-M
Fonte:
ISI
Lingua:
ENG
Soggetto:
MOLECULAR-WEIGHT HEPARIN; ACUTE MYOCARDIAL-INFARCTION; TOTAL HIP-REPLACEMENT; DEEP-VEIN THROMBOSIS; VENOUS THROMBOEMBOLISM; RECOMBINANT HIRUDIN; CORONARY-ARTERY; ANTITHROMBOTIC AGENTS; ATRIAL-FIBRILLATION; INHIBITORS;
Keywords:
anticoagulation; thrombin; heparin; coumarin; direct thrombin inhibitor (DTI); ximelagatran;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
70
Recensione:
Indirizzi per estratti:
Indirizzo: Haas, S Tech Univ Munich, Inst Expt Onkol, Ismaninger Str 22, D-81675 Munich, Germany Tech Univ Munich Ismaninger Str 22 Munich Germany D-81675 Germany
Citazione:
H. Van Aken et al., "Anticoagulation: The present and future", CL APPL T-H, 7(3), 2001, pp. 195-204

Abstract

Thrombin is a central bioregulator of coagulation and is therefore a key target in the therapeutic prevention and treatment of thromboembolic disorders, including deep vein thrombosis and pulmonary embolism. The current mainstays of anticoagulation treatment are heparins, which are indirect thrombin inhibitors, and coumarins, such as warfarin, which modulate the synthesisof vitamin K-dependent proteins. Although efficacious and widely used, heparins and coumarins have limitations because their pharmacokinetics and anticoagulant effects are unpredictable, with the risk of bleeding and other complications resulting in the need for close monitoring with their use. Low-molecular-weight heparins (LMWHs) provide a more predictable anticoagulantresponse, but their use is limited by the need for subcutaneous administration. In addition, discontinuation of heparin treatment can result in a thrombotic rebound due to the inability of these compounds to inhibit clot-bound thrombin. Direct thrombin inhibitors (DTI) are able to target both free and clot-bound thrombin. The first to be used was hirudin, but DTIs with lower molecular weights, such as DuP 714, PPACK, and efegatran, have subsequently been developed, and these agents are better able to inhibit clot-boundthrombin and the thrombotic processes that take place at sites of arterialdamage. Such compounds inhibit thrombin by covalently binding to it, but this can result in toxicity and nonspecific binding. The development of reversible noncovalent DTIs, such as inogatran and melagatran, has resulted in safer, more specific and predictable anticoagulant treatment. Oral DTIs, such as ximelagatran, are set to provide a further breakthrough in the prophylaxis and treatment of thrombosis.

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Documento generato il 30/03/20 alle ore 10:11:02