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Novel anticoagulants: How to make a choice?

Slides (presentatie) - Mar. 28, 2012

Novel anticoagulants: How to make a choice?


Deze presentatie is gehouden door:
Prof. dr. Hugo ten Cate, internist, Maastricht Universitair Medisch Centrum
tijdens de Cardio Vasculaire Conferentie op 16 maart 2012


Bekijk of download de presentatie


Novel anticoagulants: How to make a choice?

Contents

Indications (N)OACs

“Old” versus new

Synthetic oral anticoagulants

Indications for NOACs

Arterial and Venous Thrombosis

Thrombosis occurs by interaction of three elements

Atherothrombosis

Long-term anticoagulation in patients with coronary disease, and future developments.

Long-term anticoagulation in patients with coronary disease, and future developments.

Long-term anticoagulation in patients with coronary disease, and future developments.

Median D-dimer concentration over time.

Kaplan–Meier curve depicting the primary endpoint

Alexander et al, NEJM 2011


Mega et al, NEJM 2012


So how about these (N)OACs?

NOACs in ACS

Is the level of thrombin generated in blood clinically relevant?

Atherosclerotic Plaque Progression

Thrombus age after thrombosuction: proportions of treated patients (n=199).

Histological spectrum of thrombus and atherosclerotic plaque tissue retrieved by intracoronary thrombectomy.

IF STAININGS – CO-LOCALIZATION OF TF, FVII & FX

EARLY ATHEROSCLEROSIS EXHIBITS AN ENHANCED PRO-COAGULANT STATE

SIGNIFICANTLY HIGHER ETP & TAT IN EARLY ATHEROSCLEROTIC LESIONS

“What is all that thrombin for?”

Elements of blood coagulation

Elements of blood coagulation

PHENOTYPIC MODULATION OF THE ARTERIAL VESSEL WALL: NON-HEMOSTATIC ACTIONS OF KEY COAGULATION PROTEINS

Thrombin and atherosclerosis: causality?

Thrombin-induced Atherogenesis?

Thrombin being proatherogenic?

EXTENSIVE ATHEROSCLEROSIS IN TM Pro/Pro / ApoE-/- CAROTID ARTERIES

INCREASED ACCUMULATION OF MФ AND LESS α-ACTIN AND COLLAGEN I/III IN TM Pro/Pro / ApoE-/-

INTRAPLAQUE HEMORRHAGE & PLAQUE RUPTURE IN TM Pro/Pro / ApoE-/- MICE

Secondary prevention

DABIGATRAN/APC PROTECTS AGAINST SEVERE ATHEROSCLEROSIS PROGRESSION IN TM Pro/Pro / ApoE-/-

Results I/R injury : Evans Blue/TTC staining

Antithrombotic therapy

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