Supplemental Reading

Bennett JS. Novel platelet inhibitors. Annu Rev Med

2001;52:161-184. Collen D. The plasminogen (fibrinolytic) system. Thromb Haemost 1999;82:259-270.

Diener HC. Stroke prevention: Antiplatelet and antithrombotic therapy. Haemostasis 2000;30:14-26.

Ferguson JJ and Zaqqa M. Platelet glycoprotein

Ilb/IIIa receptor antagonists: Current concepts and future directions. Drugs 1999;58:965-982.

Goldhaber SZ. A contemporary approach to thrombolytic therapy for pulmonary embolism. Vasc Med 2000;5:115-123.

Hirsh J et al. Oral anticoagulants: Mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 2001;19:8S-21S.

Hirsh J et al. Heparin and low-molecular-weight hep-arin: Mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest 2001;119:64S-94S.

Lever R and Page CP. Novel drug development opportunities for heparin. Nature Rev Drug Disc 2002;1:140-148.

Levine GN, Ali MN, and Schafer AI. Antithrombotic therapy in patients with acute coronary syndromes. Arch Intern Med 2001;61:937-948.

Mannucci PM and Poller L. Venous thrombosis and anticoagulant therapy. Br J Haematol 2001;14:258-270.

Mousa SA. Antiplatelet therapies: Recent advances in the development of platelet glycoprotein IIb/IIIa antagonists. Curr Interv Cardiol Rep 1999;1:243-252.

Shord SS and Lindley CM. Coagulation products and their uses. Am J Health Syst Pharm 2000;57:1403-1417.

Sinnaeve P and Van de Werf F. Thrombolytic therapy: State of the art.Thromb Res 2001;103:S71-79.

Verstraete M. Third-generation thrombolytic drugs. Am J Med 2000;109:52-58.

Vorchheimer DA. Current state of thrombolytic therapy. Curr Cardiol Rep 1999;1:212-220.

Weitz JI. Low-molecular-weight heparins. N Engl J Med 1997;337:688-698.

^ Case Study Treatment of Thrombosis

A 23-year old pregnant woman who has been administered IV heparin for treatment of deep vein thrombosis has developed heparin-induced thrombocytopenia. Altering therapy by removing heparin and adding warfarin is not a viable option, because warfarin can cross the placenta and exert an anticoagulant effect in the fetus. Suggest a treatment approach.

Answer: Treatment of thrombosis can be initiated during pregnancy with infusion of argatroban, a direct inhibitor of thrombin. This drug does not cross the placenta and has not been reported to produce effects in the fetus. Argatroban is discontinued at the time of delivery, and thrombosis is then managed postpartum for 2 months with warfarin.

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