Acute coronary syndromes (ACS) are triggered by enhanced platelet activation and aggregation. Hence, a cornerstone
of successful secondary prevention in ACS is an effective platelet inhibition. Additionally, coronary interventions
(PCI) lead to even increased artherothrombotic risks, another challenge in preventing recurrent events including stent
thrombosis. Promising platelet targets were characterized and novel molecules were developed that are currently under investigation.
Intensified antiplatelet therapy includes the risk of major bleeding which itself increases the mortality rate.
Previous strategies of antiplatelet therapy were based on an “one-size fits all” concept. However, there has been evidence
that variability of drug response exists and represents a clinically relevant issue. This observation is in line with results of
randomized clinical trials that standard-of-care antiplatelet therapy is not sufficient to reduce cardiovascular (CV) risk in
certain subgroups of ACS patients. In the last years, novel antiplatelet substances have entered the clinical arena and others
are currently under investigation in phase II and III clinical trials. These include 3rd generation thienopyridine (prasugrel,
elinogrel), ATP analogs (Ticagrelor, cangrelor), and non-ADP-receptor blocking antiplatelet substances like thrombin
receptor antagonists. These agents have shown promising results in pilot studies and recent randomized trials. As the
prevention of atherothrombotic risk is at the expense of bleeding risk, it will be a future task to clearly define patients’
groups and subsets of ACS for the best net clinical benefit. This article focuses on the role of novel antiplatelet substances
to reduce CV risk in ACS, discuss clinical implications and their potential future role.
Keywords: Acute coronary syndrome, ADP-receptor blocker, antiplatelet therapy, ATP-analogs, novel antiplatelet agents,
ticagrelor, thienopyridine, thrombin-receptor-antagonists, thromboxane receptor antagonists, prasugrel
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