Novel Antiplatelet Agents in Cardiovascular Disease

Abstract

Antiplatelet therapy reduces atherothrombotic risk and has therefore become a cornerstone in the treatment of cardiovascular disease. Aspirin, adenosine diphosphate P2Y12 receptor antagonists, glycoprotein IIb/IIIa inhibitors, and the thrombin receptor blocker vorapaxar are effective antiplatelet agents but significantly increase the risk of bleeding. Moreover, atherothrombotic events still impair the prognosis of many patients with cardiovascular disease despite established antiplatelet therapy. Over the last years, advances in the understanding of thrombus formation and hemostasis led to the discovery of various new receptors and signaling pathways of platelet activation. As a consequence, many new antiplatelet agents with high antithrombotic efficacy and supposedly only moderate effects on regular hemostasis have been developed and yielded promising results in preclinical and early clinical studies. Although their long journey from animal studies to randomized clinical trials and finally administration in daily clinical routine has just begun, some of the new agents may in the future become meaningful additions to the pharmacological armamentarium in cardiovascular disease.

An “occlusive thrombosis-on-a-chip” microfluidic device for investigating the effect of anti-thrombotic drugs

“…Compounds that effectively prevent arterial thrombosis are still the subject of intense research (8)(9)(10). All currently-used antithrombotic drugs are limited by increased bleeding risk, including potential fatal bleeds such as intracranial haemorrhage (11)(12)(13)(14)(15).…”

Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Acute Coronary Syndrome: Implications for Platelet Reactivity?

“…Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the antithrombotic standard regimen for patients presenting with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) [1][2][3]. Prasugrel and ticagrelor are newer adenosine diphosphate (ADP) P2Y12 receptor antagonists that have been shown to be superior compared to clopidogrel in reducing adverse cardiovascular outcomes in ACS due to faster, stronger, and more consistent inhibition of ADP-induced platelet activation [4,5].…”

Impact of ABO Blood Group on Thromboembolic and Bleeding Complications in Patients with Left Ventricular Assist Devices

“…(8) It mediates the recruitment of platelets and, consecutively, early thrombus formation at the site of vascular injury or plaque rupture, particularly under conditions of high shear stress. (9) After binding to subendothelial collagen VWF undergoes conformational change and the VWF A2 domain binds to the platelet receptor GPIb. (9) Consequently, elevated levels of VWF have been associated with thrombosis and patients with blood group non-O have been reported to be at increased ischemic risk.…”

“…(9) After binding to subendothelial collagen VWF undergoes conformational change and the VWF A2 domain binds to the platelet receptor GPIb. (9) Consequently, elevated levels of VWF have been associated with thrombosis and patients with blood group non-O have been reported to be at increased ischemic risk. (10) Conversely, blood group O has been repeatedly associated with bleeding events in the general population, various disease entities, and even in patients with device therapy such as extracorporeal membrane oxygenation (ECMO).…”