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Journal of Thrombosis and Thrombolysis

, Volume 30, Issue 2, pp 240–249 | Cite as

Antiplatelet therapy for atherothrombotic disease: How can we improve the outcomes?

  • Martin Moser
  • Christoph BodeEmail author
Article
  • 100 Downloads

Abstract

Platelets play a key role in hemostasis but are also responsible for the formation of pathogenic thrombi underlying the acute clinical manifestations of vascular atherothrombotic disease. Platelets are activated by multiple pathways, including adenosine diphosphate (ADP), thromboxane A2 (TXA2), and thrombin, ultimately leading to formation of platelet-rich thrombi that occlude the arterial lumen, resulting in ischemia and cardiovascular events. Current oral antiplatelet agents inhibit the TXA2 (aspirin [ASA]) and ADP platelet activation pathways (P2Y12 ADP receptor antagonists) and have demonstrated clinical efficacy for the reduction of morbidity and mortality in patients with atherothrombotic disease. However, these agents are associated with residual risk for thrombotic events, bleeding risk, and variability in response. Thus, there is a strong clinical need for novel antiplatelet therapies that decrease the risk of thrombotic events without exposing patients to increased risk of bleeding. This review describes the clinical safety and efficacy of ASA and P2Y12 ADP receptor antagonists, the limitations of current antiplatelet therapy, and novel therapies in development, including newer P2Y12 ADP receptor antagonists and protease-activated receptor (PAR-1) inhibitors.

Keywords

ADP Thromboxane A2 Platelets Residual risk Bleeding PAR-1 

Notes

Acknowledgements

M.M. has received speaker’s honoraria from GlaxoSmithKline, Boehringer Ingelheim, and The Medicines Company. C.B. has received speaker’s honoraria from Merck, Astra-Zeneca, and Sanofi. Editorial assistance was provided by Gina Fusaro, PhD, and Joshua Barbach, MA, of Health Science Communications. This assistance was funded by Schering-Plough Corporation, now Merck & Co., Inc., Whitehouse Station, NJ, USA. The authors did not receive any financial compensation for this work and are fully responsible for the content of the manuscript.

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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Internal Medicine IIIUniversity Hospital FreiburgFreiburgGermany

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