title: Pharmacological inhibition of platelet reactivity. Clinical and pharmacodynamic effects.
abstract: Platelets play an important role in both normal hemostasis and pathological thrombus formation. The key role of platelets in thrombosis is highlighted by the clinical benefit of treatment with antiplatelet drugs. Aspirin, either alone or in combination with clopidogrel in high-risk patients, is the most widely used antiplatelet agent. However, there is an individual response to these agents that may reduce the cardiovascular protection in patients who achieve a lower antiplatelet effect. Recently, P2Y12 receptor antagonists more potent than clopidogrel (e.g., prasugrel and ticagrelor) have been approved for patients with acute coronary syndromes and those undergoing percutaneous coronary interventions; these drugs provide greater platelet inhibition than clopidogrel. However, the increased effectiveness of these treatments has underscored the importance of carefully balancing the risks of ischemia and bleeding to achieve the best clinical outcomes. The increased knowledge of the molecular mechanisms of platelet activation has prompted a search for novel pharmacological targets for the inhibition of platelet reactivity. This article reviews the molecular mechanisms of action and limitations of use of current and emerging antiplatelet agents for treatment of cardiovascular disease.
authors.affiliation: Reseach Center, University Hospital La Fe, Valencia, Spain. valles_jua@gva.es
authors.forename: Juana
authors.initials: J
authors.lastname: Vallés
authors.forename: Antonio
authors.initials: A
authors.lastname: Moscardo
authors.forename: Isabel
authors.initials: I
authors.lastname: Madrid
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Santos
mesh_terms: D000818:Animals; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000503:physiopathology; D017277:Drug Approval; D015195:Drug Design; D006487:Hemostasis; D006801:Humans; D058990:Molecular Targeted Therapy; D015539:Platelet Activation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D058919:Purinergic P2 Receptor Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D013927:Thrombosis / Q000188:drug therapy / Q000473:pathology
chemical_list: D010975:Platelet Aggregation Inhibitors; D058919:Purinergic P2 Receptor Antagonists