Anticoagulation and the heart

Cardiovascular disease is associated with a heightened risk of thrombosis t hat can manifest as acute myocardial infarction, cardiac death, and stroke. Similarly, valvular heart disease (which alters blood-flow dynamics) and t he insertion of prosthetic materials (which stimulates localized thrombosis on foreign surfaces) are associated with platelet aggregation and thrombin -mediated bioamplification of the coagulation cascade. Physiologic principl es and pathobiologic mechanisms determine the preferred means either to pre vent or attenuate both thrombosis and subsequent cardiovascular events. Ant icoagulant therapy in hospital- and outpatient-based settings has appropria tely assumed a central role in the prevention and treatment of thrombotic d isorders of the cardiovascular system. Carefully-designed clinical trials w ill establish safe and effective antithrombotic therapies for wide-scale im plementation.