Recent advances for thromboembolic disease prophylaxis and treatment in general surgery

Coagulative cascade is made by a series of enzymatic reactions that lead to sequential activation of coagulative factors. Venous thromboses are principally due to an alteration of the coagulative cascade caused by blood stasis. Without treatment, thrombus develops causing deep venous thrombosis. Thromboembolic disease is a frequent complication in surgical patients, cancer patients, chronic diseases, or in in-bed patients. In most cases, thromboembolic pathology is clinically silent. Antithrombotic prophylaxis is routinely used in medical or surgical patients according to their risk level. The most used pharmacological agents include unfractionated heparin, oral anticoagulant, and low molecular weight heparins. Recently a new drug, the pentasaccharide Fondaparinux, has been synthesized. Pentasaccharide is in a new class of antithrombotic agents, the factor Xa selective inhibitors, which bind the principal endogenous coagulative cascade inhibitor, the protein antithrombin. Despite these considerations, the incidence of thromboembolic pathology is still high and this demonstrates the demand of new antithrombotic therapies. The ideal antithrombotic drug should have a better cost-beneficial ratio and a reduced bleeding risk.