Occlusive vascular disease is a major cause of morbidity and mortality.There is now better understanding of the mechanisms by which the haemostatic system ensures blood remains fluid within vessels, yet forms a solid plug when a vessel is breached, and of the ways in which haemostasis may be altered by drugs to prevent or reverse (lyse) pathological thrombosis.

• Coagulation system: the mode of action of drugs that promote coagulation and that prevent it (anticoagulants) and their uses

• Fibrinolytic system: the mode of action of drugs that promote fibrinolysis (fibrinolytics) and their uses to lyse arterial and venous thrombi (thrombolysis)

• Platelets: the ways that drugs that inhibit platelet activity are used to treat arterial disease

The haemostatic system is complex but can be separated into the following major components:

• Formation of fibrin (coagulation), which stabilises the platelet plug

• Dissolution of fibrin (fibrinolysis)

• Platelets, which form the haemostatic plug

• Bloodvessels.

Drugs that interfere with the haemostatic system

(anticoagulants, thrombolytics, antiplatelet agents) are valuable in the management of pathological thrombus formation within blood vessels, or of pathological bleeding. They are classified according to which component of the system they affect.

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