Direct and indirect antithrombins. Heparins, low molecular weight heparins, heparinoids, and hirudin

Tick anti-hemostatics: targets for future vaccines and therapeutics

For ticks, a significant obstacle in obtaining a blood meal is counteracting the hemostatic system of the host. To this end, ticks have developed a broad array of anti-hemostatics, which is reflected in the presence of structurally related tick proteins with different functions. Disruption of blood flow which blocks successful tick feeding makes anti-hemostatics attractive targets for anti-tick vaccines. Moreover, the limited number of drugs currently available for a range of important cardio-vascular diseases makes ticks a potential source of novel therapeutics. This review aims to summarize the key features of tick anti-hemostatics, their structures, mode of action and possible future application as vaccines and novel therapeutic agents.

Management of the anticoagulated patient

Excessive bleeding or thrombosis is a preeminent concern for all surgeons. Patients may be at risk because of medical therapy, underlying disease, or complications related to both. An understanding of the coagulation cascade--mechanisms and tests of function--permits a rational, if not always complete, basis for a plan of therapy. Newer anticoagulation medications are changing how thrombotic complications, such a VTE or graft occlusion, are treated or prevented. This entire area is undergoing rapid evolution, and the approaches that have been standard for decades soon will be supplanted. Ultimately, however, the most important assessment is made at the bedside by the clinician.