Update on oral antiplatelet therapy: principles, problems and promises.
Platelets are major players in arterial thrombosis, and antiplatelet therapy has a clear clinical benefit in the treatment and prevention of cardiovascular events. In particular, aspirin and clopidogrel have become cornerstones in the treatment of patients with atherothrombosis. However, despite the proven efficacy of antiplatelet drugs, cardiovascular events remain an important cause of morbidity and mortality in these patients. Furthermore, a considerable variability in platelet reactivity during treatment with established oral antiplatelet therapy has prompted the search for novel drugs against platelet-dependent thrombosis. Possible benefits of upcoming drugs include a more efficient platelet inhibition and a reversible effect on platelet function. Aspirin, clopidogrel, prasugrel, ticagrelor, terutroban, E5555, SCH 530348 and cilostazol are discussed. This review highlights the rationale for important oral antiplatelet drugs in development and provides clinical perspectives on their pharmacological advantages and challenges.
Grove
Erik L
EL
Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, Aarhus N 8200, Denmark. erikgrove@dadlnet.dk
Kristensen
Steen D
SD
D000241:Adenosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000284:Administration, Oral; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D000077407:Cilostazol; D003324:Coronary Artery Disease / Q000188:drug therapy; D003328:Coronary Thrombosis / Q000188:drug therapy; D004351:Drug Resistance; D006801:Humans; D010879:Piperazines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride; D013777:Tetrazoles / Q000627:therapeutic use; D013876:Thiophenes / Q000627:therapeutic use; D013928:Thromboxane A2 / Q000037:antagonists & inhibitors; D000077486:Ticagrelor
D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D013876:Thiophenes; D013928:Thromboxane A2; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D000077407:Cilostazol