Novel anticoagulants in the therapy of peripheral arterial and coronary artery disease

Abstract

Anticoagulant and antiplatelet drugs are used and studied in numerous trials for primary and secondary prevention of atherothrombosis since decades. The annual rate for cardiovascular morbidity and mortality is high in patients following an acute coronary syndrome and in patients with peripheral arterial disease (PAD) due to concomitant cardiac and cerebrovascular diseases. Plaque rupture and subsequent thrombosis involves activation of both platelets and coagulation factors. Therefore the combination of aspirin and warfarin to improve prevention of atherothrombosis compared to antiplatelet therapy alone was studied but could not be established due to significantly increased risk of major bleeding compared to a nonsignificant reduction in ischemic events. During the past two decades, clinical trials focused on combined antiplatelet therapies for the prevention of secondary events following acute coronary syndromes and very recently on the new oral anticoagulants in combination with antiplatelet therapy. This review discusses the role of the new oral anticoagulants such as Factor IIa (thrombin) and Factor Xa inhibitors in atherothrombosis, their pharmacological properties and recently published clinical data in secondary prevention of atherothrombotic events and potential implications for patients with PAD.

Correlation between International Normalized Ratio values and sufficiency of two different local hemostatic measures in anticoagulated patients

“…Such drugs suppress the activation of the hemostatic system resulting in increased bleeding tendency. [ 6 7 8 ] Whether to stop, modify or continue the OAT when oral surgery is to be undertaken has long been a controversial issue. [ 9 10 ] Warfarin is one of the most commonly used anticoagulated.…”

The role of antiplatelet therapy in patients with peripheral artery disease and lower extremity peripheral artery revascularization

“…Because of these RCT results, the AHA/ACC, CHEST, and TASC II guidelines recommend against the use of warfarin and antiplatelet combination therapy for symptomatic PAD -although in cases of acute limb ischemia warfarin therapy may be necessary [6,7,17]. Newer anticoagulants such as dabigatran etexilate, rivaroxaban, and apixaban target specific elements of the coagulation cascade such as Factor Xa and thrombin, and thus may more effectively combat atherothrombotic events than warfarin, a vitamin K antagonist [64]. Ongoing RCT such as Rivaroxaban for the Prevention of Major Cardiovascular Events in Coronary or Peripheral Artery Disease and Pilot Study to Examine the Use of Rivaroxaban After Angioplasty for Critical Limb Ischemia RCT are examining the role of these new anticoagulants in PAD.…”

Thrombophilia in 153 Patients With Premature Cardiovascular Disease ≤Age 45

“…12 The clinical importance of thrombophilia in arterial thrombosis is emphasized by the superiority of oral anticoagulants versus aspirin alone in secondary prevention of acute arterial ischemia. 13,14 Since the development of the Xa inhibitors, [15][16][17] combined antiplatelet and anticoagulant therapy, particularly for secondary prevention, is now more commonly being used in patients with atherothrombosis and worsening cardiovascular disease (CVD).…”