Oral antiplatelet therapy for atherothrombotic disease: overview of current and emerging treatment options
Dan J FintelBluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USAAbstract: Clinical presentations of atherothrombotic vascular disease, such as acute coronary syndromes, ischemic stroke or transient ischemic attack, and symptomatic peripheral arterial...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2012-02-01
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| Series: | Vascular Health and Risk Management |
| Online Access: | http://www.dovepress.com/oral-antiplatelet-therapy-for-atherothrombotic-disease-overview-of-cur-a9266 |
| _version_ | 1818481432235868160 |
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| author | Fintel DJ |
| author_facet | Fintel DJ |
| author_sort | Fintel DJ |
| collection | DOAJ |
| description | Dan J FintelBluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USAAbstract: Clinical presentations of atherothrombotic vascular disease, such as acute coronary syndromes, ischemic stroke or transient ischemic attack, and symptomatic peripheral arterial disease, are major causes of morbidity and mortality worldwide. Platelet activation and aggregation play a seminal role in the arterial thrombus formation that precipitates acute manifestations of atherothrombotic disease. As a result, antiplatelet therapy has become the cornerstone of therapy for the prevention and treatment of atherothrombotic disease. Dual antiplatelet therapy with aspirin and a P2Y12 adenosine diphosphate (ADP) receptor inhibitor, such as clopidogrel or prasugrel, is the current standard-of-care antiplatelet therapy in patients with acute coronary syndromes managed with an early invasive strategy. However, these agents are associated with several important clinical limitations, including significant residual risk for ischemic events, bleeding risk, and variability in the degree of platelet inhibition. The residual risk can be attributed to the fact that aspirin and P2Y12 inhibitors block only the thromboxane A2 and ADP platelet activation pathways but do not affect the other pathways that lead to thrombosis, such as the protease-activated receptor-1 pathway stimulated by thrombin, the most potent platelet agonist. Bleeding risk associated with aspirin and P2Y12 inhibitors can be explained by their inhibitory effects on the thromboxane A2 and ADP pathways, which are critical for protective hemostasis. Interpatient variability in the degree of platelet inhibition in response to antiplatelet therapy may have a genetic component and contribute to poor clinical outcomes. These considerations underscore the clinical need for therapies with a novel mechanism of action that may reduce ischemic events without increasing the bleeding risk.Keywords: acute coronary syndromes, antiplatelet therapy, ADP, thromboxane A2, PAR-1, bleeding |
| first_indexed | 2024-12-10T11:34:59Z |
| format | Article |
| id | doaj.art-b137916b25d241c38c641ddc2a2429d4 |
| institution | Directory Open Access Journal |
| issn | 1176-6344 1178-2048 |
| language | English |
| last_indexed | 2024-12-10T11:34:59Z |
| publishDate | 2012-02-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Vascular Health and Risk Management |
| spelling | doaj.art-b137916b25d241c38c641ddc2a2429d42022-12-22T01:50:27ZengDove Medical PressVascular Health and Risk Management1176-63441178-20482012-02-012012default7789Oral antiplatelet therapy for atherothrombotic disease: overview of current and emerging treatment optionsFintel DJDan J FintelBluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USAAbstract: Clinical presentations of atherothrombotic vascular disease, such as acute coronary syndromes, ischemic stroke or transient ischemic attack, and symptomatic peripheral arterial disease, are major causes of morbidity and mortality worldwide. Platelet activation and aggregation play a seminal role in the arterial thrombus formation that precipitates acute manifestations of atherothrombotic disease. As a result, antiplatelet therapy has become the cornerstone of therapy for the prevention and treatment of atherothrombotic disease. Dual antiplatelet therapy with aspirin and a P2Y12 adenosine diphosphate (ADP) receptor inhibitor, such as clopidogrel or prasugrel, is the current standard-of-care antiplatelet therapy in patients with acute coronary syndromes managed with an early invasive strategy. However, these agents are associated with several important clinical limitations, including significant residual risk for ischemic events, bleeding risk, and variability in the degree of platelet inhibition. The residual risk can be attributed to the fact that aspirin and P2Y12 inhibitors block only the thromboxane A2 and ADP platelet activation pathways but do not affect the other pathways that lead to thrombosis, such as the protease-activated receptor-1 pathway stimulated by thrombin, the most potent platelet agonist. Bleeding risk associated with aspirin and P2Y12 inhibitors can be explained by their inhibitory effects on the thromboxane A2 and ADP pathways, which are critical for protective hemostasis. Interpatient variability in the degree of platelet inhibition in response to antiplatelet therapy may have a genetic component and contribute to poor clinical outcomes. These considerations underscore the clinical need for therapies with a novel mechanism of action that may reduce ischemic events without increasing the bleeding risk.Keywords: acute coronary syndromes, antiplatelet therapy, ADP, thromboxane A2, PAR-1, bleedinghttp://www.dovepress.com/oral-antiplatelet-therapy-for-atherothrombotic-disease-overview-of-cur-a9266 |
| spellingShingle | Fintel DJ Oral antiplatelet therapy for atherothrombotic disease: overview of current and emerging treatment options Vascular Health and Risk Management |
| title | Oral antiplatelet therapy for atherothrombotic disease: overview of current and emerging treatment options |
| title_full | Oral antiplatelet therapy for atherothrombotic disease: overview of current and emerging treatment options |
| title_fullStr | Oral antiplatelet therapy for atherothrombotic disease: overview of current and emerging treatment options |
| title_full_unstemmed | Oral antiplatelet therapy for atherothrombotic disease: overview of current and emerging treatment options |
| title_short | Oral antiplatelet therapy for atherothrombotic disease: overview of current and emerging treatment options |
| title_sort | oral antiplatelet therapy for atherothrombotic disease overview of current and emerging treatment options |
| url | http://www.dovepress.com/oral-antiplatelet-therapy-for-atherothrombotic-disease-overview-of-cur-a9266 |
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