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Oral antiplatelet agents in ischemic heart disease: a review of the latest clinical evidence

Nadia Paarup Dridi, Lene Holmvang, Peter Clemmensen

Platelet activation and aggregation play a central role in the pathophysiology of thrombogenesis in ischemic heart disease. Dual antiplatelet therapy with aspirin and clopidogrel is currently the golden standard in the prevention of cardiovascular complications after percutaneous coronary intervention. Newer antiplatelet drugs are continuously marketed to respond to the limitations of clopidogrel, namely a delayed onset of action, an irreversible inhibition of platelet aggregation as well as a substantial variability in antiplatelet effect, in part due to genetic polymorphism. The second-generation thienopyridine prasugrel is more potent than clopidogrel, but also manifests a greater bleeding risk. Ticagrelor, a third-generation thienopyridine, seems to have a better safety profile and has recently been approved as a first-choice antiplatelet treatment in acute coronary syndrome in Europe. This article will review the different oral antiplatelet drugs currently available, compare pharmacology and safety/efficacy profiles, and discuss their limitations.