Activated platelets stimulate
thrombus formation in response to
rupture of an
atherosclerotic plaque or endothelial cell erosion, promoting atherothrombotic disease. Multiple pathways contribute to platelet activation.
Aspirin, an irreversible inhibitor of
thromboxane A2 synthesis, in combination with
clopidogrel, an inhibitor of P2Y(12)
adenosine diphosphate platelet receptors, represent the current standard-of-care of antiplatelet
therapy for patients with
acute coronary syndrome and for those undergoing
percutaneous coronary intervention. Although these agents have demonstrated significant clinical benefit, the increased risk of
bleeding and the recurrence of thrombotic events represent substantial limitations.
Thrombin is one of the most important platelet activators. The inhibition of
protease-activated receptor 1 showed a good safety profile in preclinical studies. In fact, phase II studies with
vorapaxar (
SCH530348) and
atopaxar (E5555) showed no increase of
bleeding events in addition to the current standard-of-care of antiplatelet
therapy. Although the results of phase III trials for both drugs are awaited, this family is a promising new addition to the current clinical practice for patients with atherothrombotic disease, not only as an alternative, but also as additional
therapy.