title: [Platelet inhibitors in clinical practice].
abstract: Despite improvements in the treatment of acute coronary syndromes, cardiovascular disease remains the leading cause of death in Europe and the United States. Antiplatelet agents, such as aspirin and clopidogrel, play an important role in the treatment of those patients. Several new alternatives have been tested in clinical trails and some of them have been approved for routine treatment of patients with ACS in Switzerland and the European Union. The latter include Prasugrel (Efient®) and Ticagrelor (Brilique®). Those substances provide more rapid and consistent platelet inhibition but increase the risk of bleeding in some patient subgroups. Thus, the main challenge is to tailor treatment for each patient by taking into consideration patient characteristics, comorbidities, underlying short- and long-term risk factors, ischemic and bleeding risks, and expected individual responses to different medications. This ambitious new approach will be a challenge for in daily clinical work and may ultimately require prioritization among several treatment alternatives. In this article, we review the new antiplatelet agents being developed as well as their pharmacological characteristics, key interactions and side effects and potential clinical indications in subpopulations.
authors.affiliation: Institut de Cardiologie de Montréal, Montréal, Canada. catherinegebhard@msn.com
authors.forename: C
authors.initials: C
authors.lastname: Gebhard
authors.forename: J
authors.initials: J
authors.lastname: Beer
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy*; D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000627:therapeutic use; D001682:Biological Availability; D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D017277:Drug Approval; D004347:Drug Interactions; D004351:Drug Resistance; D015507:Drugs, Investigational / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D010879:Piperazines / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D012307:Risk Factors; D013876:Thiophenes / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D000077486:Ticagrelor
chemical_list: D015507:Drugs, Investigational; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D013876:Thiophenes; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine