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Introduction

Hemostasis is a physiologic process that occurs in response to vascular injury.  The process begins with the formation of a platelet plug at the site of endothelial injury (ie, primary hemostasis) ( Figure 1), which is reinforced and stabilized by a cross-linked fibrin mesh formed via the coagulation cascade (ie, secondary hemostasis) ( Figure 2).

Thrombosis is a pathologic process in which the hemostatic mechanisms are excessively activated, resulting in a clot (thrombus) that obstructs normal blood flow.  This can lead to life-threatening complications (eg, myocardial infarction [MI]) ( Figure 3).

Several antithrombotic agents have been developed to prevent and treat thromboembolic disease, including:

  • Antiplatelet agents (eg, aspirin, clopidogrel):  Prevent formation of the platelet plug.
  • Anticoagulant agents (eg, warfarin, heparin, dabigatran):  Prevent formation of the fibrin mesh by inhibiting various steps in the coagulation cascade (

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