Novel approaches to the treatment of thrombosis.

Thromboembolic diseases remain the main cause of death in Western societies despite current antithrombotic treatments. Recent advances in the molecular bases of haemostasis have highlighted new targets for novel antiplatelet or anticoagulant agents. Considering antiplatelet agents, selective antagonists of specific receptors (von Willebrand factor, collagen or thrombin receptors) are effective in thrombosis models and direct ADP receptor antagonists and nitric-oxide-releasing aspirin are in Phase I-II clinical trials. Concerning anticoagulants, inhibitors of tissue-factor-induced clotting activation, selective inhibitors of thrombin and factor Xa, and components of the anticoagulant protein C system (recombinant activated human protein C or human soluble thrombomodulin) have been studied. Some of these agents have had promising results in Phase III studies. Several achievements are anticipated from the development of new antithrombotics, including a further reduction of cardiovascular mortality and unwanted bleeding, and easier patient management.