Antithrombotic and antiplatelet effects of plant-derived compounds: a great utility potential for primary, secondary, and tertiary care in the framework of 3P medicine

Abstract

Thromboembolism is the third leading vascular disease, with a high annual incidence of 1 to 2 cases per 1000 individuals within the general population. The broader term venous thromboembolism generally refers to deep vein thrombosis, pulmonary embolism, and/or a combination of both. Therefore, thromboembolism can affect both – the central and peripheral veins. Arterial thromboembolism causes systemic ischemia by disturbing blood flow and oxygen supply to organs, tissues, and cells causing, therefore, apoptosis and/or necrosis in the affected tissues. Currently applied antithrombotic drugs used, e.g. to protect affected individuals against ischemic stroke, demonstrate significant limitations. For example, platelet inhibitors possess only moderate efficacy. On the other hand, thrombolytics and anticoagulants significantly increase hemorrhage. Contextually, new approaches are extensively under consideration to develop next-generation antithrombotics with improved efficacy and more personalized and targeted application. To this end, phytochemicals show potent antithrombotic efficacy demonstrated in numerous in vitro, ex vivo, and in vivo models as well as in clinical evaluations conducted on healthy individuals and persons at high risk of thrombotic events, such as pregnant women (primary care), cancer, and COVID-19-affected patients (secondary and tertiary care). Here, we hypothesized that specific antithrombotic and antiplatelet effects of plant-derived compounds might be of great clinical utility in primary, secondary, and tertiary care. To increase the efficacy, precise patient stratification based on predictive diagnostics is essential for targeted protection and treatments tailored to the person in the framework of 3P medicine. Contextually, this paper aims at critical review toward the involvement of specific classes of phytochemicals in antiplatelet and anticoagulation adapted to clinical needs. The paper exemplifies selected plant-derived drugs, plant extracts, and whole plant foods/herbs demonstrating their specific antithrombotic, antiplatelet, and fibrinolytic activities relevant for primary, secondary, and tertiary care. One of the examples considered is antithrombotic and antiplatelet protection specifically relevant for COVID-19-affected patient groups.

Saving High-Risk Patients from COVID-19 Severity and Death Mainly with Plant-Based Diets and Supplements

“…Our initial hypothesis that the supplements would enhance the antiinflammatory, antioxidant, immune regulatory, antithrombotic, and anti-viral properties of the PBD also explains the exceptional results of the study. The administration of antiplatelet medication to participants in our study group was another important aspect of our report, which could enhance the antithrombotic effect of PBD [38,39] and possibly help prevent the development of thrombosis in COVID-19 patients. Additionally, we were among the innovators in employing non-vitamin K antagonist oral anticoagulants (NOACs) for COVID-19 treatment, providing these medications even during the initial stages of the disease, when D-Dimer levels were only slightly elevated (with adjusted dose).…”

Plant-Based Diets and Supplements Reduced COVID-19 Severity and Achieved Zero Mortality in Elderly Patients with Multiple Comorbidities

“…The administration of antiplatelet medication to participants in the PBD group was another important aspect of our research, which could enhance the antithrombotic effect of PBD [38,39] and possibly help prevent the development of thrombosis in COVID-19 patients. Additionally, we were among the innovators in employing non-vitamin K antagonist oral anticoagulants (NOACs) for COVID-19 treatment, providing these medications even during the initial stages of the disease, when D-Dimer levels were only slightly elevated (with adjusted dose).…”

Ischemic stroke of unclear aetiology: a case-by-case analysis and call for a multi-professional predictive, preventive and personalised approach

“…Cancer-associated ischemic stroke is well-described in the literature: As reported recently, cancer pathomechanisms are functionally linked to endothelial dysfunction, coagulation abnormalities, activated pro-inflammation, and platelets adhesion, which collectively increase the risk of thromboembolism and ischemic stroke [41]. Additionally, vascular toxicity and secondary dysfunction are adverse effects of current anti-cancer therapeutics.…”

“…However, by far not every cancer patient develops stroke and not all patients with a history of stroke are at high risk of cancer. Indeed, patients with brain malignancies and cancers spreading metastases to the brain such as triple-negative breast cancer [49] are at high risk of stroke as well as cancer patients with secondary vascular dysfunction who underwent vasculo-toxic therapies causing thromboembolic type of stroke [41]. On the other hand, subtle systemic hypoxicischemic effects causing low-grade inflammation have been proposed to be involved in the development of particularly aggressive metastatic cancers [48] the pathomechanisms of which are considered to be similar to those of non-healing wounds [50].…”