Antitrombotik

Antitrombotik refers to drugs and therapies that prevent the formation of blood clots or dissolve clots that have formed. They reduce the risk of stroke, heart attack, pulmonary embolism, and venous thromboembolism in a variety of conditions. Antitrombotik therapy is usually categorized into anticoagulants, antiplatelet agents, and thrombolytics.

Anticoagulants hinder the coagulation cascade and do not directly break down existing clots. They are used for atrial fibrillation, venous thromboembolism, and artificial heart valves. Common types include vitamin K antagonists such as warfarin, heparins (unfractionated and low-molecular-weight), and direct oral anticoagulants such as dabigatran, rivaroxaban, apixaban, and edoxaban. Monitoring and bleeding risk vary: INR for warfarin; renal function and drug interactions for DOACs; aPTT for unfractionated heparin.

Antiplatelet agents prevent platelet activation and aggregation, reducing arterial thrombus formation. Aspirin is a classic example; P2Y12 inhibitors such as clopidogrel, prasugrel, and ticagrelor are also widely used. This class is a mainstay after acute coronary syndromes and for stent protection, but increases bleeding risk, particularly when combined with anticoagulants.

Thrombolytics, or fibrinolytics, actively dissolve clots by promoting plasmin formation. They are used in acute settings such as ischemic stroke within a time window, ST-elevation myocardial infarction, and certain massive pulmonary embolisms. Risks include major bleeding and intracranial hemorrhage; administration requires specialized hospital care and monitoring.

Therapy choice depends on individual factors including age, kidney function, bleeding risk, and concomitant medications. Reversal strategies exist for major bleeding, and ongoing follow-up is essential to adjust treatment and maintain safety.