Thrombosis in Cardiovascular Disorders

Abstract

The seminal discovery more than a decade ago that coronary artery thrombosis, usually caused by atherosclerotic plaque disruption, is the cause of virtually all cases of acute transmural myocardial infarction and plays a critical role in the development of unstable angina and other ischemic syndromes brought about an intense clinical and scientific interest in the process of thrombosis. The fruits of these investigations are detailed in in Cardiovascular Disorders, a remarkably up-to-date and comprehensive book. Although somewhat weighted towards thrombosis relative to cardiologic problems (fully one third of the book is concerned with coronary ischemic syndromes and thromboembolism from cardiac chambers and valves), there is in-depth coverage of thrombotic problems in other arterial beds and excellent chapters on venous thromboembolism and disseminated intravascular coagulation. On the whole the book is well balanced and reflects the backgrounds of the two editors, both distinguished leaders in cardiology and hematology from opposite sides of the Atlantic Ocean. They have selected an international group of 49 expert contributors representing the disciplines of cardiology, hematology, neurology, epidemiology, biochemistry, pharmacology, clinical medicine, and surgery. This eclectic lineup of authors is appropriate because thrombotic diseases are unusual in that they are included in the practice of most doctors, regardless of training, background, or subspecialty practice. Although the book is clinically oriented and practical, there are lucid and pithy summaries of the biochemical, pharmacologic, and molecular mechanisms involved in thrombosis and antithrombotic drugs, anticoagulants, and thrombolytic agents. In addition new agents and future therapeutic directions are nicely covered in a chapter entitled Novelties in Antithrombotic and Thrombolytic Therapy: A Latest Update. The basic pathogenesis of thrombosis is well summarized in introductory chapters that emphasize the interrelationship between cell to cell, molecular, and biochemical interactions as influenced by changes in the deformation of blood flow. There is a fascinating early chapter entitled Interrelationship Between Atherosclerosis and Thrombosis that lends compelling modern scientific support for Duguid's encrustation theory of atherogenesis. The bulk of this book, however, is intensely practical, with solid advice from experts on the management of thrombotic disease. A hallmark is that the opinions are backed by scholarship based on data from sound clinical trials and a thorough understanding of basic and theoretic considerations. The book is well edited. Each editor independently refereed each chapter, most of which were resubmitted in revised form within a 3-month deadline. The entire project was completed within 6 months, and many of the references are within I year of the 1992 publication date. Although there is variation in emphasis and opinion, there is a minimum of overlap and redundancy. There are two reservations. First, the chapter on peripheral arterial disease is disappointing. That it is written by European internists (angiologists) is apparent in the idiomatic phrasing (terminoterminal anastomosis in the aorta for end-to-end anastomosis), occasional misstatements (Streptokinase has been the most widely used agent for peripheral arterial occlusion), and curious misunderstandings (the . . . so-called blue toe syndrome is secondary to obstruction of the microcirculation in patients with essential or secondary thrombocythemia). Although there is useful information to be gleaned from this chapter, most American vascaflar surgeons will find it somewhat rambling and difficult to understand. The second reservation is the paucity of coverage of prethrombotic or hypercoagulable states. Although mentioned in passing in several chapters, the book would benefit from an in-depth chapter on congenital and acquired hypercoagulable syndromes. Despite these reservations this book can be recommended as an up-to-date, authoritative, and scholarly resource on thrombotic disorders. Anyone treating patients with arterial and thromboembolic disease would benefit from owning it; obviously, this includes vascular surgeons.