title: Safety and efficacy of targeting platelet proteinase-activated receptors in combination with existing anti-platelet drugs as antithrombotics in mice.
abstract: OBJECTIVE
  Developing novel anti-platelet strategies is fundamental to reducing the impact of thrombotic diseases. Thrombin activates platelets via proteinase-activated receptors (PARs), and PAR antagonists are being evaluated in clinical trials for prevention of arterial thrombosis. However, one such trial was recently suspended due to increased bleeding in patients receiving a PAR₁ antagonist in addition to anti-platelet drugs that most often included both aspirin and clopidogrel. Therefore, it remains unclear how to best manipulate PARs for safe antithrombotic activity. To address this, we have examined potential interactions between existing anti-platelet drugs and strategies that target PARs.
  
  
  METHODS
  We used in vivo mouse models in which interactions between various anti-platelet strategies could be evaluated. We examined the effects on thrombosis and haemostasis in PAR₄ -/- mice (platelets unresponsive to thrombin) treated with therapeutic doses of either aspirin or clopidogrel.
  
  
  RESULTS
  Using a model in which occlusive thrombosis occurred in PAR₄ -/- mice or wild-type mice treated with aspirin or clopidogrel, PAR₄ -/- mice treated with either anti-platelet agent showed marked protection against thrombosis. This antithrombotic effect occurred without any effect on haemostasis with aspirin, but not clopidogrel. Furthermore, specifically targeting thrombin-induced platelet activation (via PARs) improved the therapeutic window of non-specifically inhibiting thrombin functions (via anticoagulants).
  
  
  CONCLUSIONS
  Our results indicate that PAR antagonists used in combination with aspirin provide a potent yet safe antithrombotic strategy in mice and provide insights into the safety and efficacy of using PAR antagonists for the prevention of acute coronary syndromes in humans.
authors.affiliation: Australian Centre for Blood Diseases, Monash University, Melbourne, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Lee
authors.forename: S A
authors.initials: SA
authors.lastname: Sturgeon
authors.forename: J K
authors.initials: JK
authors.lastname: Mountford
authors.forename: S P
authors.initials: SP
authors.lastname: Jackson
authors.forename: J R
authors.initials: JR
authors.lastname: Hamilton
mesh_terms: D000818:Animals; D001241:Aspirin / Q000494:pharmacology / Q000627:therapeutic use*; D000077144:Clopidogrel; D004195:Disease Models, Animal; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006487:Hemostasis / Q000187:drug effects; D051379:Mice; D018345:Mice, Knockout; D015539:Platelet Activation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D044462:Receptors, Proteinase-Activated / Q000037:antagonists & inhibitors* / Q000502:physiology; D013927:Thrombosis / Q000188:drug therapy* / Q000503:physiopathology; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D044462:Receptors, Proteinase-Activated; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin