Figure 1. Role of platelets and the coagulation cascade in atherothrombosis and vascular inflammation.

Atherothrombosis involves atherosclerotic plaque rupture or erosion and the formation of an intravascular thrombus. The atherosclerotic plaque contains agents, such as collagen, that activate platelets, and tissue factor (TF) that activates the coagulation cascade. Aspirin reduces the thrombus by inhibiting platelet activation. Anticoagulants reduce the thrombus by inhibiting fibrin generation and also by reducing thrombin activation of platelets. These inhibitors include the thrombin inhibitor dabigatran etexilate and the factor Xa inhibitors rivaroxaban, apixaban, edoxaban or betrixaban. Activated platelets and activation of protease-activated receptors (PARs) by coagulation proteases may also increase inflammation in the vessel wall. Aspirin and anticoagulants may also reduce vascular inflammation and limit the progression of atherosclerosis.