Current Cardiology Reports

, Volume 13, Issue 4, pp 303–311

Beyond Aspirin and Clopidogrel: Is There a Need for Additional Antiplatelet Therapy in ACS?

Article

DOI: 10.1007/s11886-011-0195-0

Cite this article as:
Rajan, L. & Moliterno, D.J. Curr Cardiol Rep (2011) 13: 303. doi:10.1007/s11886-011-0195-0

Abstract

Dual antiplatelet therapy with aspirin and clopidogrel is a well-established standard of care for patients with acute coronary syndromes. Whether there are other drug strategies or therapies that will achieve fewer ischemic events, and at the same time be associated with fewer bleeding complications, is a question recurrently asked. Finding the appropriate pharmacologic calibration of antiplatelet potency and applying such a pharmacodynamic effect to all patients has only been partially successful. The shadow of this one-size-fits-all dilemma is now being recast with the arrival of newer antiplatelet agents, which are attempting to decouple antithrombotic potency from bleeding liability. Novel antiplatelet agents that act faster and have more consistent pharmacokinetics and higher potency are steadily emerging. Additionally, newer agents that target unique sites, such as the thrombin receptor on platelets, are being studied in large-scale clinical trials. Each of these new agents has the potential to extend net clinical benefits beyond those provided by aspirin and clopidogrel.

Keywords

Acute coronary syndromes Antiplatelet therapy Aspirin Clopidogrel 

Clinical Trial Acronyms

BRIDGE

Maintenance of Platelet Inhibition with Cangrelor After Discontinuation of Thienopyridines in Patients Undergoing Surgery

CHAMPION PLATFORM

Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition

COGENT

Clopidogrel and the Optimization of Gastrointestinal Events

CREDO

Clopidogrel for the Reduction of Events During Observation

CURE

Clopidogrel in Unstable Angina to Prevent Recurrent Ischemic Events

CURRENT OASIS 7

Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events—Seventh Organization to Assess Strategies in Ischemic Symptoms

ERASE-MI

Elinogrel Before PCI to Optimize Reperfusion in Acute Myocardial Infarction

GRAVITAS

Gauging Responsiveness with A Verify Now Assay-Impact on Thrombosis and Safety

INNOVATE-PCI

Intravenous and Oral Administration of Elinogrel, a Selective and Reversible P2Y12-Receptor Inhibitor, Versus Clopidogrel to Evaluate Tolerability and Efficacy in Nonurgent Percutaneous Coronary Interventions Patients

ISAR--REACT

Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment

LANCELOT-ACS

Lesson from Antagonizing the Cellular Effect of Thrombin in Acute Coronary Syndromes

PLATO

Platelet Inhibition and Patient Outcomes

TRA-PCI

Thrombin Receptor Antagonist-Percutaneous Coronary Intervention

TRACER

Thrombin Receptor Antagonist for Clinical Events Reduction

TRA2P-TIMI 50

Thrombin-Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events

TRITON-TIMI 38

Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Division of Cardiovascular Medicine, Gill Heart InstituteUniversity of KentuckyLexingtonUSA

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