Aggressive antithrombotic therapy with ASA, thienopyridine, GPIIb/IIIa inhbitors, eparin, and Vit.K antagonist (VKA) is used for unstable angina (UA), myocardial infarction (NSTEMI), acute coronary syndrome (ACS), stent implantation, atrial fibrillation (AF),VTE. The main findings of combination of antithrombotic drugs are their association with serious bleeding not withstanding some respectable benefit, and a great effects against thrombosis. At present the preferred approach for the long term treatment is VKA the dose should be adjusted to maintain a target INR of 2.5 (range: 2.0 to 3.0), the controversy focused in a patients with a high risk of recurrence a high intensity VKA therapy (INR: 3.1 to 4.0) although did not confirm a superiority in terms of thrombotic protection, new opportunities have emerged in the treatment of arterial thrombosis with the combinations of antithrombotic drugs (ASA 325mg every days, plus thienopyridine: ticlopidine 250mg orally twice a day, or clopidogrel / GPIIb-IIIa antagonist/ anticoagulant: VKA, LMWH, fondaparinux) with a significant inhibition of thrombosis but always a remarkable and unacceptable bleeding risk, and a narrow safety window. Question: what are the very primary strong end points (death, PE or symptomatic VTE, Myocardial infarction or stroke, recurrence!), or are the inhibition of platelet functions, of signalling pathways, of atherosclerotic process monitoring. Several trials have evaluated the role of long term anticoagulation therapy, and a high intensity anticoagulation and combination therapy with a marvel issue (by 32% to 48% reduction of the risk of relapse) but a burdensome toll of side effects (bleeding by 4.8% to 8.2%). We have studied 118 patients with a tailored therapy and individual strategies selecting the disease and comorbility, the dose, the timing, the manner, the potential validity and the variance of individual responses with a significant reduction of side effects (bleeding by 0.8% to 2.4%), and a preserved therapeutic benefit (by 34% to 44% reduction of the risk of relapse). Answers: the optimal management of antithrombotic therapy is the reduction of side events, and the mainstay of treatment is to maintain patency of the vessels, but it's not so easy, certainly the main road is to have a drug made to be measured.
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Asterisk with author names denotes non-ASH members.