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Novel anticoagulants: How to make a choice?
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Contents
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Indications (N)OACs
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“Old” versus new
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Synthetic oral anticoagulants
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Indications for NOACs
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Arterial and Venous Thrombosis
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Thrombosis occurs by interaction of three elements
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Atherothrombosis
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Long-term anticoagulation in patients with coronary disease, and future developments.
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Long-term anticoagulation in patients with coronary disease, and future developments.
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Long-term anticoagulation in patients with coronary disease, and future developments.
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Median D-dimer concentration over time.
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Kaplan–Meier curve depicting the primary endpoint
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Alexander et al, NEJM 2011
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Mega et al, NEJM 2012
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So how about these (N)OACs?
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NOACs in ACS
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Is the level of thrombin generated in blood clinically relevant?
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Atherosclerotic Plaque Progression
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Thrombus age after thrombosuction: proportions of treated patients (n=199).
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Histological spectrum of thrombus and atherosclerotic plaque tissue retrieved by intracoronary thrombectomy.
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IF STAININGS – CO-LOCALIZATION OF TF, FVII & FX
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EARLY ATHEROSCLEROSIS EXHIBITS AN ENHANCED PRO-COAGULANT STATE
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SIGNIFICANTLY HIGHER ETP & TAT IN EARLY ATHEROSCLEROTIC LESIONS
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“What is all that thrombin for?”
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Elements of blood coagulation
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Elements of blood coagulation
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PHENOTYPIC MODULATION OF THE ARTERIAL VESSEL WALL: NON-HEMOSTATIC ACTIONS OF KEY COAGULATION PROTEINS
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Thrombin and atherosclerosis: causality?
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Thrombin-induced Atherogenesis?
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Thrombin being proatherogenic?
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EXTENSIVE ATHEROSCLEROSIS IN TM Pro/Pro / ApoE-/- CAROTID ARTERIES
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INCREASED ACCUMULATION OF MФ AND LESS α-ACTIN AND COLLAGEN I/III IN TM Pro/Pro / ApoE-/-
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INTRAPLAQUE HEMORRHAGE & PLAQUE RUPTURE IN TM Pro/Pro / ApoE-/- MICE
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Secondary prevention
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DABIGATRAN/APC PROTECTS AGAINST SEVERE ATHEROSCLEROSIS PROGRESSION IN TM Pro/Pro / ApoE-/-
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Results I/R injury : Evans Blue/TTC staining
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Antithrombotic therapy
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06.tenCate (PDF 8,9MB)
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