A Neglected Possible Clinical Management for Surgery for Patients at Risk of Peri-Operative Thrombosis

Background: Excessive bleeding occurs when anti-thrombotic drugs for patients with thrombotic risk are administered in the context of surgical operations and trauma. Purpose: Analysis of data from the published literature on the mechanism of occlusive arterial thrombosis and evaluation of the most likely drug intervention that might circumvent this problem. Results: Activation of platelets by haemodynamic factors appeared to be more important than plaque rupture and arterial endothelial factors in the process of arterial thrombosis within arterial stenoses. The process was accelerated by the well established serotonin to serotonin positive feedback thrombus growth mechanism. Much animal experimental data attest to the inhibition of this process by 5HT2A receptor antagonism. Serotonin is not involved in the hemostasis of wounds. Conclusion: Pure serotonin 5HT2A antagonists will not increase traumatic bleeding and can be administered during surgical operations and the peri-operative period.