Antistollings

Antistollings, or antithrombotic therapy, refers to medicines and measures that reduce the formation of blood clots (thrombi). They are used to prevent and treat thrombosis in arteries and veins and encompass several drug classes, including anticoagulants, antiplatelet agents, and, in acute settings, thrombolytics.

Anticoagulants work by inhibiting various steps of the coagulation cascade to prevent clot growth. Vitamin K antagonists, such as warfarin, reduce production of vitamin K–dependent clotting factors. Heparins, including unfractionated heparin and low molecular weight heparin, enhance antithrombin activity. Direct oral anticoagulants inhibit factor Xa (for example, apixaban, rivaroxaban, edoxaban) or thrombin (dabigatran). Anticoagulants are commonly used to prevent stroke in atrial fibrillation, to protect mechanical heart valves, and to treat or prevent venous thromboembolism.

Antiplatelet agents inhibit platelet activation or aggregation and are particularly important in arterial settings. Aspirin inhibits platelet cyclooxygenase, while P2Y12 inhibitors such as clopidogrel, prasugrel, and ticagrelor block ADP receptor–mediated platelet activation. These drugs are central to preventing events after acute coronary syndromes and in coronary artery disease.

Thrombolytics, such as tissue plasminogen activator, dissolve clots in selected acute situations but are used less for long‑term prevention due to bleeding risk. Monitoring and safety considerations include INR monitoring with warfarin, renal function assessment for DOACs, hematologic monitoring for heparin, and reversal strategies in cases of serious bleeding. Bleeding is the principal risk, balanced against thrombotic risk in individual patients.