Novel Anti-platelet Agents for the Treatment of Stable Angina Pectoris

Alexandros      Briasoulis; Dimitris      Tousoulis; Constantinos      Bakogiannis; Nikolaos      Papageorgiou; Emmanuel      Androulakis; George      Latsios; George      Chatzis; Christina      Chrysohoou; Georgia      Vogiatzi; Christodoulos      Stefanadis

Abstract

Antiplatelet treatment is an important element in the medical treatment of patients with stable angina. Single antiplatelet therapy with low-dose aspirin is recommended in the absence of contraindications in all patients with diagnosed chronic stable angina and ischemic heart disease. Dual antiplatelet therapy is recommended initially for all patients with stable angina undergoing elective angioplasty with the duration of P2Y12 antagonist administration depending on the type of coronary stent. Despite the demonstrated clinical benefit in a wide range of patients, residual risk of ischemic events with aspirin and a P2Y12 inhibitor has also been attributed to the fact that these agents do not inhibit all pathways involved in platelet activation and aggregation. Other platelet activation pathways, including the PAR-1 pathway activated by thrombin (the most potent platelet activator), remain active in the presence of current antiplatelet agents. A combination of current therapies with novel agents could provide more comprehensive platelet inhibition leading to incremental decrease of cardiovascular events at the expense of increased bleeding risk. The current review presents traditional and novel antiplatelet treatment options and discusses the indications for aggressive antiplatelet management in patients with stable angina pectoris.

Keywords: Aspirin, stable angina, P2Y12 antagonists, antiplatelet treatment, contraindications, ischemic heart disease, dual antiplatelet therapy, coronary stent, thrombin, bleeding risk