Beyond platelet inhibition: potential pleiotropic effects of ADP-receptor antagonists

The adenosine diphosphate (ADP) receptor antagonists, specifically the class of thienopyridines, have emerged as potent tools in the clinician's arsenal for the treatment of athero-thrombotic disease over the last two decades. Though these medications have been clearly demonstrated to have significant platelet-inhibiting effects, their potential positive impact on other systemic processes has been less well elucidated. Recent evidence points to a number of potential pleiotropic effects of these agents, most notably in the attenuation of several pro-inflammatory pathways, which may be independent of their anti-platelet-aggregating effect. Additionally, several new ADP receptor antagonists are under investigation; it remains to be seen if these agents possess any additional beneficial pleiotropic properties as well.