Thrombosis in cardiovascular medicine: a review of pathophysiology, mechanisms of drug action, and the "alphabet" of established and emerging therapies.

Thrombosis is a physiologic hemostatic response to vascular injury. Thrombus generation has evolved as a complex event involving multiphasic biologic inputs and regulation. Pathologic thrombosis in cardiovascular medicine afflicts millions of U.S. citizens per year, exacting a death total in the hundreds of thousands of people. These morbid events are particularly common in the settings of trauma, major surgery, and high-risk medical patients both inside and outside of the hospital. The frequency of all of these risks increases as our population grows and ages. The discussion that follows sketches the roots of our understanding of pathologic thrombosis through a clinical case example, a highlight of the historically key concepts involved, identification of the phasic inputs into thrombus formation and regulation, and a listing of the therapeutics and agents used in treating the thrombosis "epidemic".