Novel antiplatelet agents in cardiovascular medicine.

OPINION STATEMENT: Dual antiplatelet therapy with aspirin and a P2Y12 receptor blocker, particularly clopidogrel, has been the standard of therapy for secondary prevention in patients with acute coronary syndromes and patients treated with percutaneous coronary intervention. More potent P2Y12 inhibitors such as ticagrelor and prasugrel are associated with better pharmacodynamic effect and improved clinical outcomes but are associated with an increased risk of bleeding compared to clopidogrel. In addition, the observation of treatment failure in ~10 % of high-risk patients treated with aspirin and a potent P2Y12 inhibitor is another major concern. Personalized antiplatelet therapy based on therapeutic winnow concept for P2Y12 receptor blocker may facilitate the balance between reducing ischemic events and avoiding bleeding events, thereby improving net clinical outcome. New class of agents like vorapaxar has been approved by the FDA to reduce thrombotic events in patients with a history of myocardial infarction or with peripheral arterial disease. In addition, new P2Y12 receptor and protease-activated receptor (PAR)-1 receptor antagonists and agents targeting intracellular signaling downstream from G protein-coupled receptors are among the novel strategies under investigation to prevent arterial ischemic event occurrences.