Antiplatelet treatment of cardiovascular disease: a translational research perspective.
Platelet mediated thrombosis is the primary cause of ischemic event occurrence in patients with cardiovascular disease. The P2Y12 receptor plays a central role in thrombus generation and is therefore a major target for pharmacologic therapy. Although various clinical trials have demonstrated the efficacy of dual antiplatelet therapy with aspirin and clopidogrel, recurrent ischemic events occur in approximately 10% of patients with acute coronary artery syndromes. Recent translational research studies have explored the various limitations of dual antiplatelet therapy including wide response variability and resistance. The association of ischemic event occurrence with high on-treatment platelet reactivity to adenosine diphosphate has been reported in recent small studies suggesting that the latter may be a quantifiable and modifiable risk factor. Recent studies have identified a potential therapeutic target for P2Y12 inhibitors that may influence the future development of personalized antiplatelet treatment strategies aimed at the reduction of ischemic event occurrence in high risk patients. Finally, based on the current evidence platelet reactivity may become a standard of care risk factor measured in all patients with cardiovascular disease.
Gurbel
Paul A
PA
Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA. pgurbel@lifebridgehealth.org
Antonino
Mark J
MJ
Tantry
Udaya S
US
D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D001241:Aspirin / Q000494:pharmacology / Q000627:therapeutic use; D000077144:Clopidogrel; D003328:Coronary Thrombosis / Q000188:drug therapy*; D004351:Drug Resistance; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D018048:Receptors, Purinergic P2 / Q000378:metabolism; D058925:Receptors, Purinergic P2Y12; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use
C548576:P2RY12 protein, human; D010975:Platelet Aggregation Inhibitors; D018048:Receptors, Purinergic P2; D058925:Receptors, Purinergic P2Y12; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin