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EXPERT COMMENT
Year : 2017  |  Volume : 4  |  Issue : 3  |  Page : 84

Antithrombotics: Do We Know Enough?


Department of Vascular Surgery, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication31-Jul-2017

Correspondence Address:
Edwin Stephen
Department of Vascular Surgery, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_34_17

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How to cite this article:
Stephen E. Antithrombotics: Do We Know Enough?. Indian J Vasc Endovasc Surg 2017;4:84

How to cite this URL:
Stephen E. Antithrombotics: Do We Know Enough?. Indian J Vasc Endovasc Surg [serial online] 2017 [cited 2017 Sep 19];4:84. Available from: http://www.indjvascsurg.org/text.asp?2017/4/3/84/211910



Thromboembolic events are a significant cause of mortality and morbidity the world over, be it venous or arterial. Arterial thromboembolism is considered to be platelet rich and can present like a stroke, myocardial infarction or an acute limb. Venous thromboembolism, on the other hand, contains lower platelets and more fibrin, which traps red blood cells. Hence, a clear need for different antithrombotic drug therapy in the two.

Eminent German physician Rudolf Virchow (1821–1902) described the triad of irritation of the vessel wall, stasis, and hypercoagulability for venous thrombosis, and received credit for his contribution decades after his death. Virchow did not consider the endothelial injury to be a cause of thrombosis and disagreed with Jean Cruveilhier, who felt that pulmonary artery thrombosis was primarily from vessel wall injury.

Virchow'striad is seemed to have given an explanation for the cause of thrombosis and present day research is trying to find answers to the sequelae that follow and the ideal treatment to reduce the morbidity, mortality, and financial burden from the them.

Some of the key questions regarding anti-thrombotics that need to be addressed are:

  • Do we know enough about the pathophysiology of thrombosis to focus on newer drugs alone?
  • Do we need more trials to access safety, efficacy, and superiority of newer drugs?
  • Would patients who need more than one antithrombotic be able to have a single drug that would equate the potency of dual or triple therapy without compromising on safety?
  • Role of anticoagulants with or without anti-platelets in arterial thrombosis?
  • Antithrombotic management of patients with – obesity, renal failure, elderly, pregnancy
  • Genetic and polymorphism studies – their effect on drug levels
  • Development of affordable antidote's for newer oral anticoagulants.


Answers to these questions will come from conducting randomized controlled trials (RCTs), research and use of technological advancements.

As a nation, we need to focus on introducing an attitude of research from the time a person enters the medical profession and encourage the same. A questioning mind once identified should be guided by the senior fraternity to formulate the study, seek funding, conduct it, and publish. The government has set aside a significant amount of money through the offices of the Department of Science and Technology, Department of Biotechnology, and The Indian Council of Medical Research.

Arterial and venous thromboembolism is being seen increasingly all across India. We have come a long way in managing these patients and improving outcomes in these patients. Several advances have been made. However, a lot still remains to be done. Spread across our nation are centers of excellence with clinicians, researchers, laboratories, who along with government and the medical industry need to work together to conduct RCT's for further clarity on a condition which remains frosty more than a century after Virchow and Cruveilhier.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

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