Antiplatelet Therapy in Cardiovascular Diseases

Sai Krishna Chebrolu; Raja Sekhar D; Gayathri Budagala; Babu Rao Chandu

doi:10.37022/jis.v8i1.103

Chebrolu Sai Krishna Priyadarshini Institute of Pharmaceutical Education and Research-5th Mile, ulladigunta, Guntur-522017 Andhra Pradesh, India
D. Raja Sekhar Priyadarshini Institute of Pharmaceutical Education and Research-5th Mile, ulladigunta, Guntur-522017 Andhra Pradesh, India
Budagala Gayathri Priyadarshini Institute of Pharmaceutical Education and Research-5th Mile, ulladigunta, Guntur-522017 Andhra Pradesh, India
Chandu Babu Rao Priyadarshini Institute of Pharmaceutical Education and Research-5th Mile, ulladigunta, Guntur-522017 Andhra Pradesh, India

DOI https://doi.org/10.37022/jis.v8i1.103

Abstract

Antiplatelet therapy is essential in preventing arterial blockages that can lead to serious conditions such as heart attacks, strokes, and peripheral artery disease. Traditionally, aspirin and clopidogrel have been the mainstays of treatment, but advancements have introduced more potent options like prasugrel, ticagrelor, and glycoprotein IIb/IIIa inhibitors. Researchers are also exploring newer agents-such as intravenous Conqueror and protease-activated receptor-1 antagonists-to further enhance treatment strategies. Each antiplatelet drug works differently. Aspirin prevents clot formation by blocking a key enzyme, while clopidogrel requires metabolic activation to become effective. Newer drugs like prasugrel and ticagrelor act faster and are often more effective, particularly in emergency situations. However, selecting the right therapy is complex and depends on several factors, including a patient’s genetics, which can influence both drug response and the risk of side effects. As the field evolves, newer medications are expanding the options for preventing blood clots while carefully balancing the risk of bleeding. Ongoing research remains crucial-not only to refine treatment strategies but also to explore aspirin’s emerging role in cancer prevention. Personalized therapy is the future, ensuring that patients receive the most effective and safest treatment based on their individual needs.

Keywords: Antiplatelet therapy, Aspirin, Clopidogrel, Prasugrel, Ticagrelor, Personalized therapy

References

1. Stark K, Massberg S. Interplay between inflammation and thrombosis in cardiovascular pathology. Nature Reviews Cardiology. 2021 Sep;18(9):666-82. https://doi.org/10.1038/s41569-021-00552-1
2. Capodanno D, Ingala S, Calderone D, Angiolillo DJ. Aspirin for the primary prevention of cardiovascular disease: latest evidence. Expert review of cardiovascular therapy. 2019 Sep 2;17(9):633-43.
https://doi.org/10.1080/14779072.2019.1651199
3. Clark MG, Beavers C, Osborne J. Managing the acute coronary syndrome patient: Evidence based recommendations for anti-platelet therapy. Heart & Lung. 2015 Mar 1;44(2):141-9.
https://doi.org/10.1016/j.hrtlng.2014.11.005
4. Shattil SJ, Newman PJ. Integrins: dynamic scaffolds for adhesion and signaling in platelets. Blood. 2004 Sep 15;104(6):1606-15.
https://doi.org/10.1182/blood-2004-04-1257
5. Pisters R, Lane DA, Nieuwlaat R, De Vos CB, Crijns HJ, Lip GY. A novel user- friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010 Nov 1;138(5):1093-100. https://doi.org/10.1378/chest.10-0134
6. Patrono C, García Rodríguez LA, Landolfi R, Baigent C. Low-dose aspirin for the prevention of atherothrombosis. New England Journal of Medicine. 2005 Dec 1;353(22):2373-83.
https://doi.org/10.1093/eurheartj/ehy813
7. Ahn HS, Crim W, Romano M, Sybertz E, Pitts B. Effects of selective inhibitors on cyclic nucleotide phosphodiesterases of rabbit aorta. Biochemical pharmacology. 1989 Oct 1;38(19):3331-9.
https://doi.org/10.1016/0006-2952(89)90631-X
8. Iwamoto T, Kin K, Miyazaki K, Shin K, Takasaki M. Recovery of platelet function after withdrawal of cilostazol administered orally for a long period. Journal of atherosclerosis and thrombosis. 2003;10(6):348-54.
https://doi.org/10.5551/jat.10.348
9. Fox KA, Mehta SR, Peters R, Zhao F, Lakkis N, Gersh BJ, Yusuf S. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non–ST-elevation acute coronary syndrome: the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) Trial. Circulation. 2004 Sep 7;110(10):1202-8. https://doi.org/10.1161/01.CIR.0000140675.85342.1B
10. Wallentin L, James S, Storey RF, Armstrong M, Barratt BJ, Horrow J, Husted S, Katus H, Steg PG, Shah SH, Becker RC. Effect of CYP2C19 and ABCB1 single nucleotide polymorphisms on outcomes of treatment with ticagrelor versus clopidogrel for acute coronary syndromes: a genetic substudy of the PLATO trial. The Lancet. 2010 Oct 16;376(9749):1320-8.
https://doi.org/10.1016/S0140-6736(10)61274-3
11. Kiranmai M, Renuka P, Brahmaiah B, Chandu BR. Vitamin D as a promising anticancer agent.
https://doi.org/10.1161/ATVBAHA.116.308050
12. Yeung J, Holinstat M. 12-lipoxygenase: a potential target for novel anti-platelet therapeutics. Cardiovascular & Hematological Agents in Medicinal Chemistry (Formerly Current Medicinal Chemistry-Cardiovascular & Hematological Agents). 2011 Jul 1;9(3):154- 64.
https://doi.org/10.2174/187152511797037619
13. Nama S, Chandu BR, Awen BZ, Khagga M. Development and validation of a new RP-HPLC method for the determination of aprepitant in solid dosage forms. Tropical Journal of Pharmaceutical Research. 2011;10(4):491-7. https://doi.org/10.1161/ATVBAHA.120.315154
14. Buchiraju R, Nama S, Sakala B, Chandu BR, Kommu A, Chebrolu JK, Yedulapurapu N. Research Journal of Pharmaceutical, Biological and Chemical Sciences.
15. Gindi S, Methra T, Chandu BR, Boyina R, Dasari V. Antiurolithiatic and invitro anti-oxidant activity of leaves of Ageratum conyzoides in rat. World J. Pharm. Pharm. Sci. 2013 Feb 8;2:636-49.https://doi.org/10.1161/01.CIR.0000140675.85342.1B
16. Dara SR. An Overview of the Use of Natural Indicators in Acid-Base Titrations. UPI Journal of Pharmaceutical, Medical and Health Sciences. 2024 Jul 23:29-35.
https://doi.org/10.1016/j.ahj.2011.04.006
17. Farid NA, Payne CD, Small DS, Winters KJ, Ernest CS, Brandt JT, Darstein C, Jakubowski JA, Salazar DE. Cytochrome P450 3A inhibition by ketoconazole affects prasugrel and clopidogrel pharmacokinetics and pharmacodynamics differently. Clinical Pharmacology & Therapeutics. 2007 May;81(5):735-41.
https://doi.org/10.1038/sj.clpt.6100139
18. Iwamoto T, Kin K, Miyazaki K, Shin K, Takasaki M. Recovery of platelet function after withdrawal of cilostazol administered orally for a long period. Journal of atherosclerosis and thrombosis. 2003;10(6):348-54.
https://doi.org/10.5551/jat.10.348
19. Van Doren L, Nguyen N, Garzia C, Fletcher EK, Stevenson R, Jaramillo D, Kuliopulos A, Covic L. Lipid receptor GPR31 (G-protein–coupled receptor 31) regulates platelet reactivity and thrombosis without affecting hemostasis. Arteriosclerosis, thrombosis, and vascular biology. 2021 Jan;41(1):e33-45.
https://doi.org/10.1161/ATVBAHA.120.315154
20. Hiatt WR, Fowkes FG, Heizer G, Berger JS, Baumgartner I, Held P, Katona BG, Mahaffey KW, Norgren L, Jones WS, Blomster J. Ticagrelor versus clopidogrel in symptomatic peripheral artery disease. New England Journal of Medicine. 2017 Jan 5;376(1):32-40. https://doi.org/10.1161/CIRCULATIONAHA.116.025880