Background: Apart from the acute thrombotic complications that lead to acute
coronary syndromes (ACS), platelet activation also plays an important role in the initiation
and progression of atherosclerosis. In addition, it is speculated that anti-platelet therapy can
be beneficial for patients with stable coronary artery disease (CAD). Of note, patients on
optimal anti-platelet treatment still experience thrombotic events, whereas complications,
such as bleeding, cannot be ignored. In this light, novel antiplatelet regimens have been
used to minimize the residual platelet activation without compromising normal haemostasis.
Methods: We performed a thorough search of the literature in order to review the beneficial
role of novel antiplatelets in patients with stable CAD. We have also focused on studies that
examine the effect of these drugs on platelet reactivity as well as on cardiovascular outcomes.
Conclusion: Specific agents, such as vorapaxar and cilostazol, have been found to
reduce platelet reactivity as well as to improve patients’ prognosis. Of note, the use of novel
antiplatelets is of clinical importance in patients with increased thrombotic status and in those with resistance to
classic antiplatelets. However, the available data on most of the novel antiplatelets are mainly derived from studies
including ACS patients undergoing angioplasty Therefore, large randomized controlled studies are required
to evaluate the clinical benefit of novel antiplatelets in patients with stable CAD.