[Anticoagulation for secondary prevention: which drug in which situation?].

Thromboembolic events are a major complication of cardiovascular diseases. Secondary prevention of thromboembolic complications can be achieved by anticoagulation with heparin or vitamin-K-antagonists. A new class of direct thrombin inhibitors has been recently introduced into clinical medicine. Clinical studies have demonstrated theses agents to be comparable in efficacy for prophylaxis of venous thromboembolism. However, the results of ongoing trials are awaited in helping to define the place of direct thrombin inhibitors in secondary prevention. Antiplatelet therapy constitutes the cornerstone in the management of patients with acute coronary syndromes and generally high-risk patients with atherothrombosis. Until recently, long-term antiplatelet therapy for the treatment and prevention of atherothrombotic disease was traditionally limited to aspirin. The availability of the thienopyridines and glycoprotein IIb/IIIa inhibitors represents an important addition to the physician's armamentarium. Due to the increased risk of major bleeding, for each patient the decision of anticoagulation and antiplatelet therapy must be tightly correlated to the individual benefit-risk ratio.