title: Overcoming limitations of current antiplatelet drugs: a concerted effort for more profitable strategies of intervention.
abstract: Platelets play a central role in the pathophysiology of atherothrombosis, an inappropriate platelet activation leading to acute ischemic complications (acute myocardial infarction, ischemic stroke). In view of this, platelets are a major target for pharmacotherapy. Presently, the main classes of antiplatelet agents approved for the use in such complications are aspirin and thienopyridines. Although antiplatelet treatment with these two types of drugs, alone or in combination, leads to a significant reduction of non-fatal myocardial infarction (-32%), non-fatal stroke (-25%), and of cardiovascular death (-17%), a residual risk persists. Newer antiplatelet agents have addressed some, but not all, these limitations. Vis-à-vis their net clinical benefit, the higher potency of some of them is associated with a rise in bleeding complications. Moreover, newer thienopyridines do not show advantages over and above the older ones as to reduction of stroke. A concerted effort that takes into consideration clinical, genetic, and laboratory information is increasingly recognized as a major direction to be pursued in the area. The well-established road signs of clinical epidemiology will provide major information to define newer potentially useful targets for platelet pharmacology.
authors.affiliation: Department of Clinical and Experimental Medicine, Regional Reference Centre for Coagulation Disorders, 'Federico II' University, Naples, Italy.
authors.forename: Matteo Nicola Dario
authors.initials: MN
authors.lastname: Di Minno
authors.forename: Anna
authors.initials: A
authors.lastname: Guida
authors.forename: Marina
authors.initials: M
authors.lastname: Camera
authors.forename: Susanna
authors.initials: S
authors.lastname: Colli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Minno
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
mesh_terms: D001241:Aspirin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D050197:Atherosclerosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016503:Drug Delivery Systems; D015195:Drug Design; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D058924:Thienopyridines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D013927:Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*
chemical_list: D010975:Platelet Aggregation Inhibitors; D058924:Thienopyridines; D001241:Aspirin