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 Drugs in Vascular Disease

Anticoagulants (mechanism of action, clinical use, complications, monitoring of the anticoagulant effect).

  • Heparin (unfractionated and low molecular weight).
  • Heparinoids (danaparoid).
  • Warfarin.
  • Hirudin.
  • Ancrod.

Thrombolytic agents (source, mechanism of action, complications, monitoring of the fibrinolytic effect).

  • First-generation agents (streptokinase and urokinase).
  • Second-generation agents (recombinant tissue plasminogen activator and antistreplase).
  • Third-generation agents (reteplase).

Antiplatelet medications (mechanism of action, complications).

  • Aspirin.
  • Dipyridamole.
  • Ticlopidine.
  • Clopidogrel.
  • Abciximab.

IV Claudication drugs (mechanism of action, clinical use, complications).

  • Pentoxifylline.
  • Dextran.
  • L-carnitine, L-propionylcarnitine.
  • Cilostazol.

Serotonergic agents (mechanism of action, clinical use, complications).

Vasodilator drugs (mechanism of action, clinical use, complications).

  • Direct acting drugs (papaverine, isoxuprine, cyclandelate).
  • α -adrenergic blockers (guanethidine, phenoxybenzamine, prazosin, tolazoline, phentolamine).
  • Prostaglandins (PGE, PGI).
  • β- stimulating drugs (nylidrin).
  • Calcium channel blockers (nifedipine, verapamil, diltiazem, amlodipine, felodipine, isradipine, nicardipine, nimodipine).
  • Nitrates (nitroprusside).

References

Frangos SG, Chen AH, Sumpio B. Vascular drugs in the new millennium. J Am Coll Surg 2000;191:76-92.

This review discusses pharmacologic therapy of cardiovascular disorders including antiplatelet agents, anticoagulants, thrombolytics, and claudication-alleviating drugs. Each drug category is introduced with a brief review of the current "gold standard" medication, with emphasis on the limitations and weaknesses that the newer agents have been designed to overcome.

Ginsberg JA, Crowther MA, White RH, Ortel TL. Anticoagulation therapy. Hematology (Am Soc Hematol Educ Program) 2001;:339-57.

A broad spectrum of issues related to anticoagulation therapy is presented in this article, including initiation and control of anticoagulation therapy, a comparison between unfractionated and low molecular weight heparin, and the management of the “problem patient” who requires anticoagulants.

Doggrell SA. Pharmacotherapy of intermittent claudication. Expert Opin Pharmacother 2001;2:1725-1736.

Several drugs are currently used for patients with intermittent claudication: pentoxifylline, cilostazol, naftidrofuryl, inhibitors of platelet aggregation (including nitric oxide from L -arginine or glyceryl trinitrate), anticoagulants (low molecular weight heparin, defibrotide) and intravenous or oral prostaglandins. The evidence supporting the use of these drugs is summarized by the author and new approaches to the treatment of intermittent claudication, including propionyl-L-carnitine and basic fibroblast growth factor, are outlined.

Jaff MR. Pharmacotherapy for peripheral arterial disease: emerging therapeutic options. Angiology 2002;53:627-633.

An overview of pharmacotherapy for peripheral arterial disease is provided by the author of this article. The properties of pentoxifylline and cilostazol are reviewed and new therapeutic opportunities offered by angiogenic growth factors are presented.

Hiatt WR. Medical treatment of peripheral arterial disease and claudication. N Engl J Med 2001;344:1608-1621.

This review focuses on risk-factor modification and antiplatelet therapies, as well as strategies for symptomatic relief in patients with peripheral arterial disease. Evaluation of patients with suspected peripheral arterial disease as well as evaluation and treatment of patients with proven peripheral arterial disease are also summarized.

Posted June 2010