Paperback: 394 pages
Data: December 10, 2001
Format: PDF
Description: This book covers many of the topics in vascular medicine that currently are prominent in the scientific, clinical, and lay press. Part I deals with mechanisms of hypercoagulability; the roles of cells, cytokines, and inflammation in the pathogenesis of arterial disease; genetic and environmental aspects of homocysteine metabolism in cardiovascular disease; antiphospholipid-antibody syndromes; and the epidemiology of cardiovascular disease in postmenopausal women who take hormone-replacement therapy. Four cases that demonstrate difficult decisions in the care of patients with antiphospholipid antibodies elucidate the myriad manifestations of this syndrome in a particularly helpful manner. Part II summarizes the evidence justifying current antithrombotic therapy. Summaries of landmark multicenter, randomized clinical trials, both in the United States and elsewhere, lead the reader along a logical path through the mounting evidence that supports the safety and efficacy of unfractionated and low-molecular-weight heparins, direct thrombin inhibitors, glycoprotein IIb/IIIa inhibitors, aspirin and the newer platelet antagonists, and angiotensin-converting-enzyme inhibitors. The outcomes of combination therapy with anticoagulants, thrombolytic agents, and platelet inhibitors are presented and assessed. The coverage of trials focuses primarily on acute coronary syndromes; cerebrovascular and peripheral arterial disease receive less attention. This section organizes the confusing panoply of megatrials and makes effective use of figures and tables to illustrate outcomes and toxic effects seen with various drugs, classes of drugs, and drug combinations in patients with thrombotic events. Judicious discussion of meta-analyses helps to synthesize the overwhelming amount of data into cogent principles. A welcome feature is the concluding paragraph of each chapter, which summarizes current evidence-based practice and outlines salient questions for future and ongoing trials. Section III deals with diagnostic and therapeutic interventions for arterial disease. Section IV, in which the discussion deviates into the holistic treatment of venous thromboembolism, encompasses genetic and acquired thrombophilia, noninvasive and invasive diagnostic techniques and algorithms, thrombolysis, and the organization of integrated comprehensive care for medical management and follow-up. Data relating the outcomes of therapy for venous thromboembolism to the duration of anticoagulation or underlying thrombophilia are nicely displayed in helpful figures. Section V ends with a discussion of catheter-based and surgical interventions for venous disease. This section envisions future explorations of therapy beyond doses, durations, and combinations of antithrombotic drugs and investigates the role of the physical removal of clots, alone or with clot lysis. This book will appeal to generalists, internists, family physicians, medical residents, and students. The emphasis is practical and clinical. There are no weighty discussions of basic science or molecular mechanisms. Biochemical pathways are depicted simply and clearly, with an emphasis on application to practice. Complex clinical trials are not dissected in detail but, rather, are presented in an organized fashion to support global concepts of safety and efficacy. One aspect of the book that I found disappointing was the omission of any mention of infants or children, an important group of patients in whom thromboembolism has been subjected to recent intense clinical scrutiny.
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