ABSTRACT
Many new antithrombotic and antiplatelet drugs have been developed that have markedly
improved prophylaxis and treatment of thrombotic diseases. Clopidogrel, a potent new
antiplatelet compound, is the first clinical alternative to aspirin for long-term
oral treatment and prevention of arterial thrombosis. Another new, exciting category
of antiplatelet compounds is the GPIIb/IIIa-antagonists, the first antiintegrins in
clinical use and the most potent inhibitors of platelet aggregation. Low molecular
weight heparins (LMWHs) are the quantitatively dominating group of new antithrombotics,
which has replaced unfractionated heparin for the prophylaxis and treatment of venous
thromboembolism. Current clinical evidence suggests that LMWHs might replace unfractionated
heparin for the treatment and prophylaxis of atherothrombotic complications in acute
coronary syndromes in the near future. Fondaparinux is the first synthetic pentasaccharide
and a selective inhibitor of factor Xa with exciting clinical data; it could become
an alternative LMWH for prophylaxis of arterial and venous thromboembolism in high-risk
patients. The field of oral thrombin inhibitors is still dominated by the coumarins.
However, much effort is being undertaken to develop new orally active drugs from which
ximelagatran is currently the leading compound with a predicted better safety and
efficacy profile. Alternatively, inhibitors of factor VIIa might be of interest as
well. Open questions include, in particular, the possible individualization of drug
therapy in dependence on the kind of disturbed platelet function or blood hypercoagulability,
respectively.
KEYWORDS
Antiplatelet drugs - antithrombotics - aspirin - clopidogrel - GPIIb/IIIa antagonists
- low molecular weight heparins
