Antiplatelet drugs are the cornerstone of therapy in many cardiovascular conditions. With the current
success and increased use of transcatheter aortic valve implantation (TAVI), the use of antiplatelet therapy is considered
part of the medical therapy for these patients. Clinicians caring for these patients need to have a thorough
understanding of the pharmacology, pharmacokinetics, pharmacodynamic, and clinical efficacy and safety of
commonly used antiplatelet therapy. While aspirin therapy is widely used, dual antiplatelet therapy with clopidogrel
has become part of standard of care. Despite the extensive experience with clopidogrel, there are limitations
such as drug interactions, metabolism genetic polymorphisms, and variability in the antiplatelet response. More
predictable and more potent antiplatelet agents, prasugrel and ticagrelor, have demonstrated superior reductions in
ischemic endpoints as part of dual antiplatelet therapy compared to clopidogrel, but at the cost of more major bleeding in patients with an
acute coronary syndrome. Significant research needs to be conducted in the setting of TAVI to help define the optimal antiplatelet regimen.
Keywords: Aspirin, clopidogrel, prasugrel, ticagrelor, antiplatelet agents, P2Y12 inhibitors.
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