Newer Antiplatelet Agents for Interventional Indications

Modern interventional cardiology is based on two main cornerstones: improved devices such as drug-eluting stents and fast, strong-acting anticoagulants. Clopidogrel is a prodrug which requires a two-step process in the liver to obtain its active state. This process involves the cytochrome P450 (CYP P450)-dependent pathway. The use of clopidogrel in combination with aspirin in comparison with aspirin alone significantly reduced the risk for major cardiovascular events in acute coronary syndrome (ACS) patients and in elective coronary angioplasty with stent implantation. Proven variability in clopidogrel antiplatelet action due to genetic factors prompted the Food and Drug Administration (FDA) to add a black box warning concerning clopidogrel drug information. Prasugrel is a new, third-generationthienopyridine-class oral antiplatelet prodrug, which becomes activated more rapidly and efficiently than clopidogrel. Ticagrelor is a new oral inhibitor of P2Y12 that provides a more rapid and complete antiplatelet effect than clopidogrel.