Purpose of review: Cardiovascular events are still a major concern despite dual antiplatelet treatment with aspirin and clopidogrel. Moreover, recent developments that improved platelet inhibition were associated with increased bleeding complications, suggesting that personal dose adjustment might be needed. This review is dedicated to new developments in antiplatelet agents other than ADP P2Y12 receptor blockers, which are discussed in a separate article of this issue.
Recent findings: The thrombin receptor protease activable receptor-1 antagonist SCH530348 and the thromboxane receptor antagonist terutroban are two promising agents that are now undergoing phase III clinical trials. Cilostazol, a phosphodiesterase III inhibitor, is currently tested in phase IV trials for several new indications. Despite previous disappointing results with oral GPIIbIIIa antagonists, new compounds with unique features are under development. In addition, targeting intracellular signaling pathways is a new area of research, with several attractive targets.
Summary: Recent development of new antiplatelet agents, including inhibitors of thrombin receptor, thromboxane receptor, phosphodiesterase, glycoprotein VI, GPIIbIIIa and signaling pathways, may lead to a more effective and yet safe antiplatelet therapy with an improved clinical outcome.