Minireviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. May 26, 2016; 8(5): 327-332
Published online May 26, 2016. doi: 10.4330/wjc.v8.i5.327
P2Y12-ADP receptor antagonists: Days of future and past
Marc Laine, Franck Paganelli, Laurent Bonello
Marc Laine, Franck Paganelli, Laurent Bonello, Cardiology Department, CHU NORD, Chemine des Bourrely, 13015 Marseille, France
Author contributions: Laine M is the main author; Bonello L and Paganelli F reviewed and revised the manuscript.
Conflict-of-interest statement: Marc Laine has received consulting fees and lecture fees from AstraZeneca. Laurent Bonello has received consulting fees, research grant and lecture fees from AstraZeneca. Franck Paganelli has consulting fees from AstraZeneca.
Open-Access: This article is an open-access article which was selected byan in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marc Laine, MD, Cardiology Department, CHU NORD, Chemine des Bourrely, AP-HM, 13015 Marseille, France. marc.laine@ap-hm.fr
Telephone: +33-4-91968858 Fax: +33-4-91968979
Received: May 4, 2015
Peer-review started: May 12, 2015
First decision: July 27, 2015
Revised: December 23, 2015
Accepted: January 21, 2016
Article in press: January 22, 2016
Published online: May 26, 2016
Abstract

Antiplatelet therapy is the cornerstone of the therapeutic arsenal in coronary artery disease. Thanks to a better understanding in physiology, pharmacology and pharmacogenomics huge progress were made in the field of platelet reactivity inhibition thus allowing the expansion of percutaneous coronary intervention. Stent implantation requires the combination of two antiplatelet agents acting in a synergistic way. Asprin inhibit the cyclo-oxygenase pathway of platelet activation while clopidogrel is a P2Y12 adenosine diphosphate (ADP)-receptor antagonist. This dual antiplatelet therapy has dramatically improved the prognosis of stented patients. However, due to pharmacological limitations of clopidogrel (interindividual variability in its biological efficacy, slow onset of action, mild platelet reactivity inhibition) ischemic recurrences remained high following stent implantation especially in acute coronary syndrome patients. Thus, more potent P2Y12-ADP receptor inhibitors were developped including prasugrel, ticagrelor and more recently cangrelor to overcome these pitfalls. These new agents reduced the rate of thrombotic events in acute coronary syndrome patients at the cost of an increased bleeding risk. The abundance in antiplatelet agents allow us to tailor our strategy based on the thrombotic/bleeding profile of each patient. Recently, the ACCOAST trial cast a doubt on the benefit of pre treatment in non-ST segment elevation acute coronary syndrome. The aim of the present review is to summarize the results of the main studies dealing with antiplatelet therapy in stented/acute coronary syndromes patients.

Keywords: Clopidogrel, Prasugrel, Ticagrelor, Acute coronary syndrome, Ticagrelor, Cangrelor

Core tip: Antiplatelet therapy in coronary artery disease has dramatically changed during the past few years. From ticlodipine to cangrelor, the present review summarizes the results of the main studies dealing with this hot topic of cardiology.