Understanding Antithrombotic Agents for Rehabilitation Therapy: A Comprehensive Narrative Review

Abstract

In rehabilitation medicine, attention must be paid to the medication. Among them, antithrombotic drugs are used for the initial treatment and secondary prevention of stroke, so as a basic knowledge, the pharmacological actions, characteristics, indications, and precautions for the use of antithrombotic drugs should be known. Antithrombotic agents are divided into antiplatelet agents and anticoagulants, and the appropriate antithrombotic agent is selected according to the main disease or condition. Antiplatelet agents include aspirin, clopidogrel, ticlopidine, prasugrel, ticagrelor, and cilostazol. Each antiplatelet agent has a different mechanism of action, characteristics, and indications, and should be prescribed with due consideration. Anticoagulants include heparin, synthetic Xa inhibitors, direct oral anticoagulants (DOACs), synthetic antithrombin agents, and warfarin. Knowledge of the mechanism of action, characteristics, and indications of each anticoagulant is necessary, as well as monitoring and dose adjustment. With regard to ischemic cerebrovascular disease (ICD) and antithrombotic agents, the first step is to classify cerebral infarction and to determine whether antiplatelet agents or anticoagulants should be used. Bleeding and recurrence prevention are important considerations in the selection of appropriate antithrombotic agents for the pathophysiology of ICD.

Keywords: anticoagulant drugs; antiplatelet agent; antithrombotic agent; direct oral anticoagulant (doac); ischemic cerebrovascular disease; rehabilitation medicine; risk of bleeding; stroke.

Figure 1. Mechanisms of platelet activation and mechanisms of action of antiplatelet agents

Figure created by the author 5HT2: 5-hydroxytryptamine 2, ADP: adenosine diphosphate, TXA2: thromboxane A2, PAR-1: protease-activated receptor-1, vWF: von Willebrand factor, GP: glycoprotein, PLC: phospholipase C, DG: I, 2-diacylglycerol, GMP: guanosine monophosphate, AMP: adenosine monophosphate, GC: guanylate cyclase, AC: adenylate cyclase, NO: nitric oxide, PG: prostaglandin, IP receptor: prostacyclin receptor

Figure 2. Action mechanism of warfarin

Figure created by the author PIVKA: protein induced by vitamin K absence or antagonists