ABSTRACT
This chapter reviews the importance of intraarterial thrombosis in coronary atherosclerotic disease, in saphenous vein bypass graft disease, and in the development of postangioplasty occlusion and restenosis. Antithrombotic therapy can be divided into platelet inhibitors, heparin, and oral anticoaguants. The chapter discusses the role of antithrombotic therapy in each of the clinical entities that make up the acute coronary syndromes. Platelets that are deposited release vasoconstricting compounds which contribute to episodes of reduced coronary caliber and ischemia, either silent or symptomatic. The value of antithrombotic therapy in unstable angina has been conclusively demonstrated by two randomized, placebo-controlled double blind trials involving the use of aspirin. Many advocate the use of intravenous heparin rather than aspirin during hospitalization to avoid the risk of aspirin-related bleeding perioperatively if coronary artery bypass surgery is needed. Thrombolytic therapy represents a major advance in the treatment of acute myocardial infarction. Intraventricular mural thrombi are commonly found at autopsy in patients with acute myocardial infarction.
