Description: This multiauthored entry in the Fundamental and Clinical Cardiology series is divided into four sections covering an overview, new heparins and thrombin inhibitors, new antiplatelet agents, and new thrombolytic agents.
Purpose: It has been five years since the first edition came out. This is a rapidly advancing field, and more information has developed in the last few years that required a new understanding of hemostasis. There are many new agents targeting various steps in the hemostasis cascade.
Audience: This book will appeal to hematologists, but it will also appeal to cardiologists who deal with these agents on a daily basis. Cardiology fellows would find much worthwhile here as well.
Features: The book starts with a review of the clotting cascade and a critical review of clinical trial design, e.g., the lack of placebo controls, equivalences, no inferiority track, the small patient numbers in subgroups of small trials, and inconsistent end-points. The trials in low molecular weight heparin and its role in the acute coronary syndrome are reviewed, as well as those with glycoprotein IIb/IIIa inhibitors. The role of low molecular weight heparin in pregnancy is reviewed, as are new indications for low molecular weight heparin, generally (for example, transluminal coronary angioplasty, inflammatory bowel disease, sepsis, and Alzheimer's disease). The agent Argatroban is the smallest molecule in the class of thrombin inhibitors, and can penetrate and neutralize thrombin at a two-fold increase in concentration. This agent is important in heparin-induced thrombocytopenia and thrombosis, as well as in those patients who require a percutaneous intervention. Hirudin and Bivaluridin are reviewed, and a comparison with unfractionated heparin is reviewed. The new oral agents, Ximelagatrin and Pentasaccharide are important antithrombotic agents in development. The role of tissue factor pathway inhibitor in thrombosis is reviewed, with an emphasis on transluminal coronary angioplasty, cerebral vascular accidents, and gliomas. The importance of protein C and S as antithrombotics will always be important in certain areas, especially warfarin-induced skin necrosis. The interaction of protein C and S with thrombomodulin and thrombosis is well described. There are chapters on the glycoprotein IIb/IIIa receptor blockers. Over 100 pages of the book are devoted to new data on thrombolytic therapy. The epilogue summarizes the present, and points to the future use of anticoagulation.
Assessment: When compared to the first edition, the first few chapters pf this book are nearly the same, but the rest is enhanced by new developments in this important area. The book is full of important information, and is a definite addition to the medical literature. Many of the chapters have more than 100 references to original work.