Bloedverdunning anno 2016

Willemsen r, dinant gj, verheugt f, ten cate h, weerkamp n. Anticoagulation in 2016. Huisarts wet 2016;59(7):312-8. This article provides an overview of current antithrombotic therapy, a topic about which general practitioners often have questions. The pathophysiology of thrombus formation and the different types of currently available oral antithrombotic drugs are described, and then the preferred antithrombotic regimen for individual indications is discussed. Pathological thrombus formation is caused by either venous thrombosis (as is the case in pulmonary embolism) or arterial thrombosis (as is the case in myocardial infarction and stroke without atrial fibrillation). In both cases, antithrombotic medication is usually indicated. There are two main groups of oral antithrombotic drugs: antiplatelet drugs and anticoagulants. The former are usually indicated when there is a high risk of arterial thrombosis; for example, in stable coronary artery disease, peripheral artery disease, and stroke. In contrast, oral anticoagulants are usually indicated in the case of venous thrombosis or an increased risk thereof (atrial fibrillation, deep venous thrombosis, or pulmonary embolism). However, the preferred type of antithrombotic agent varies by indication. Although the risk of major bleeding should be taken into consideration, it is rarely an absolute contraindication for antithrombotic therapy. Occasionally combinations of different antithrombotic agents are indicated. For example, two different antiplatelet drugs maybe preferred instead of monotherapy in certain situations, such as after myocardial infarction, and two or three drugs can be used in patients with previous myocardial infarction and atrial fibrillation.