Platelet and Thrombin Inhibitors as Adjuncts to Thrombolytic Therapy and Percutaneous Coronary Interventions: A Review

A large body of evidence supports the critical role of thrombus formation in the pathogenesis of acute MI as well as the early ischemic complications after percutaneous coronary interventions. Both platelets and the plasma proteins involved in fibrin formation are intimately involved in the thrombotic process. Recently, pharmacological agents that hinder fibrin formation and platelet activation or aggregation have been developed. These drugs are being tested in patients with acute MI, in conjunction with thrombolytic agents, and in patients undergoing percutaneous coronary interventions. So far, the antiplatelet agents appear very promising in the area of percutaneous coronary intervention. Information on their role in acute myocardial infarction is still too preliminary to draw conclusions. Results with antithrombin agents have been less promising. This article will briefly describe the mechanisms of thrombus formation, detail the mechanism of action of available antithrombotic pharmacological agents, and review recent clinical trials of these agents.