[New antiaggregants and their importance for the practitioner]

Area of Science:

• Cardiology
• Pharmacology

Background:

• Aspirin has been a cornerstone antiplatelet therapy since the 1950s.
• Several newer agents, including clopidogrel and GPIIb/IIIa blockers, have emerged with antiplatelet effects.
• Few agents have demonstrated superiority over aspirin in all clinical settings.

Purpose of the Study:

• To review the efficacy and safety of newer antiplatelet agents compared to aspirin.
• To discuss the role of clopidogrel and GPIIb/IIIa blockers in various cardiovascular conditions.
• To explore practical considerations for using these agents in specific patient populations.

Main Methods:

• Review of existing clinical trial data and pharmacological profiles of antiplatelet agents.
• Comparative analysis of aspirin, clopidogrel, and GPIIb/IIIa blockers in secondary prevention.
• Discussion of clinical applications and limitations.

Main Results:

• Clopidogrel demonstrates a better safety profile than ticlopidine and can be an alternative to aspirin in specific secondary prevention scenarios.
• The combination of aspirin and clopidogrel is superior to aspirin alone for unstable angina or myocardial infarction without ST-segment elevation.
• Oral GPIIb/IIIa blockers have shown insufficient cardiovascular event protection compared to aspirin.

Conclusions:

• Clopidogrel is a valuable alternative for aspirin-intolerant patients or those with recurrent events on aspirin.
• Further evidence is needed to support the general substitution of aspirin with clopidogrel.
• The combination therapy of aspirin plus clopidogrel shows significant benefits in specific acute coronary syndromes, with potential for broader application pending further research.