CRC NEW THRP AGNT THROMB THROMBL PDF

Preface

Since the publication of the first edition of New Therapeutic Agents in Thrombosis and Thrombolysis book five years ago, our understanding of the determinants of the hemostatic cascade has evolved considerably. We continue to learn more about the intricacies of the primary and secondary hemostatic and fibrinolytic pathways, and to be surprised at or disappointed with the results of the clinical applications of different agents targeted to these pathways. Recently, there has been a flurry of activity in developing new pharmaceutical agents that target both conventional and newly characterized pathways of hemostasis. These agents, which generally impair coagulation, include low-molecular-weight heparins, direct thrombin inhibitors, tissue factor pathway inhibitors, and an oral form of unfractionated heparin. New agents have been produced to minimize the prothrombotic activity of activated platelets, such as thienopyridines and the glycoprotein IIb/IIIa receptor antagonists. New thrombolytic agents are also being developed and tested to achieve greater efficacy of thrombolysis and to do so with fewer bleeding complications, especially intracranial hemorrhage.

The book is divided into four parts. The first begins with an overview of new developments in hemostasis and thrombolysis, followed by two other useful overviews. The ‘‘Design Issues in Clinical Trials'' overview reflects the current thinking of the FDA on the development of these new agents. Parts II and III focus on new heparins, thrombin inhibitors, and other new agents. Chapters on low-molecular-weight heparins have been updated based on newer clinical studies, for example, on hirudin, bivalirudin, and protein C. Notably, new chapters have been added on pentasaccharide, TFP1, and soluble thrombomodulin.

In the last part, on thrombolytic agents, additional clinical studies have been included on variants of t-PA, as well as on staphylokinase and prourokinase. Alfimeprase is a new and novel thrombolytic agent that is not a plasminogen activator. The last chapter discusses recent work on thrombolysis enhancement with ultrasound.

We are grateful to our distinguished section editors who remained with us from the first edition: Jeffrey Weitz, Jack Hirsh, James Willerson, and Marc Verstraete. We are also grateful to our new section editors: Robert Giugliano, Shaker Mousa, and Samuel Goldhaber. We also wish to thank Stephanie Tribuna, editorial assistant to Dr. Loscalzo. Special thanks to Sandra Beberman, Vice President, Marcel Dekker, Inc., who convinced us to undertake this second edition, and to Richard Johnson, Production Editor, who gave us continued support throughout the process.