Antithrombotic therapy: new areas to understand efficacy and bleeding.
INTRODUCTION: Therapeutic options for antithrombotic therapy are limited due to associated adverse bleeding events. Traditionally, the antithrombotic effects of these agents have been closely linked with concomitant risks in bleeding complications. AREAS COVERED: This article will review recent developments in the understanding of the mechanisms underlying physiological hemostasis and pathological thrombosis as well as key findings that may serve to 'uncouple' these two processes. In addition, we highlight the recent work identifying novel therapeutic agents targeting these novel mechanisms of pathological thrombus formation. EXPERT OPINION: Recent research has identified several novel mediators of thrombus formation, including cell-free nucleic acids, histones, histone-DNA complexes and neutrophil extracellular traps that may serve to link inflammation and thrombosis as well as separate physiological hemostasis from pathological thrombosis. Researchers are developing ligands to target these mediators with an achievable goal to identify novel therapies that inhibit thrombus formation without increased bleeding risk.
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