Guided antithrombotic therapy: current status and future research direction: report on a National Heart, Lung and Blood Institute working group.

The National Heart, Lung, and Blood Institute (NHLBI) convened a working group to develop a research agenda to enhance the understanding and effectiveness of antithrombotic therapy. The working group brought together cardiologists, hematologists, interventionalists, clinical trialists, genetic epidemiologists, basic scientists, and other stakeholders to review (1) coagulation, platelet activation and aggregation, and antithrombotic therapy; (2) issues surrounding antithrombotic therapy failure – how to define it, how to predict and diagnose it, available tests and how to optimize them; (3) the factors that affect the efficacy, safety, and predictability of antithrombotic therapies; (4) how to optimize antithrombotic therapy, improve on present interventions, and individually tailor therapy to increase efficacy and safety and to avoid failure; and (5) the clinical applicability and cost-effectiveness of individually tailored antithrombotic therapy based on functional and genetic testing. The working group characterized and discussed challenges for guided antithrombotic therapy in 4 domains: therapeutic strategies, antithrombotic metrics, pharmacology and pharmacogenetics, and stakeholders' roles. Overall, the working group identified and prioritized the most pressing clinical needs to focus future research and translational efforts. This report presents highlights of these reviews and a summary of suggested research directions. There has been tremendous progress in the field of thrombosis in the past 2 decades.1–5 The ramifications on cardiovascular care have been profound. A greater appreciation of the central role of platelets in atherothrombosis and an increased understanding of the receptors involved in platelet activation and aggregation have led to pivotal randomized controlled trials (RCTs) of novel agents.6 Many of these agents have been associated with substantial reductions in adverse cardiovascular outcomes. Simultaneously, an appreciation of the complexity of the coagulation cascade and the artificiality of separating it from cellular and platelet interactions has promoted a deeper understanding of thrombosis and, consequently, identification of pharmacological targets to …

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