New antiplatelet drugs and new oral anticoagulants

Abstract

In our daily anaesthetic practice, we are confronted with an increasing number of patients treated with either antiplatelet or anticoagulant agents. During the last decade, changes have occurred that make the handling of antithrombotic medication a challenging part of anaesthetic perioperative management. In this review, the authors discuss the most important antiplatelet and anticoagulant drugs, the perioperative management, the handling of bleeding complications, and the interpretation of some laboratory analyses related to these agents.

Endothelial dysfunction and platelet hyperactivity in type 2 diabetes mellitus: molecular insights and therapeutic strategies

“…Various antiplatelet and anticoagulant drugs have been suggested as novel therapeutic strategies to improve platelet function in T2DM [231–237]. Acetylsalicylic acid (aspirin), a cyclooxygenase (COX) inhibitor, has been known to have anti-inflammatory and antithrombotic properties from past several decades [233, 234].…”

“…However, in recent studies, low-dose aspirin was found to be associated with increased risk for gastrointestinal bleeding in T2DM patients in a primary prevention setting [238]. In addition, for long-term treatment or prevention of thromboembolic complications, use of oral anticoagulants is recommended [231]. From the past decades, vitamin K antagonists have been shown to have anticoagulant properties.…”

“…However, risk of a recurrent event among patients with venous thromboembolism has shown to be decreased with rivaroxaban at either a treatment dose (20 mg) or a prophylactic dose (10 mg) than with aspirin, without a significant increase in bleeding rates [243]. Furthermore, P2Y12 receptor antagonists such as clopidogrel, ticagrelor, prasugrel and cangrelor have been shown to chemically block the adenosine diphosphate (ADP) receptors (P2Y12) [231]. The overall effect on platelet includes reduction in platelet aggregation, conformational changes, emergence of pseudopodia and interaction with other cellular or plasma components involved in coagulation [244].…”

“…The overall effect on platelet includes reduction in platelet aggregation, conformational changes, emergence of pseudopodia and interaction with other cellular or plasma components involved in coagulation [244]. Furthermore, Glycoprotein IIb/IIIa inhibitors such as Abciximab, tirofiban and eptifibatide, inhibit the fibrinogen adhesion to activated platelet, blocking the formation of interplatelet bridges [231, 245, 246]. Furthermore, various anticoagulants have been shown to prevent the initiation as well as progression of coagulation and fibrin-clot formation/propagation [237, 247, 248].…”

The Two Faces of Thrombosis: Coagulation Cascade and Platelet Aggregation. Are Platelets the Main Therapeutic Target?

“…Currently, combination therapy of antiplatelet agents (aspirin plus an inhibitor of P2Y12 receptor) or even triple therapy (based on antiplatelet drugs plus anticoagulant agents) may be considered because of high risk of thromboembolism in patient affected by arterial thrombosis (i.e patients affected by atrial fibrillation undergoing coronary stent implantation). In the last decade newer antiplatelet drugs have proven their efficacy in combination with aspirin in reducing major cardiovascular events in patients presenting with acute coronary syndrome [53,54].…”