[Update: oral platelet inhibitors in cardiology]

The antithrombotic therapy in patients with atherosclerotic vascular disease is subject of several new therapeutic approaches. Simultaneous treatment with acetylsalicylic acid (ASS) and a thienopyridine (clopidogrel) represents the standard of care for patients with acute coronary syndrome and following coronary stenting recommended by many guidelines. Without true evidence this drug combination is used for the prevention of arterial thrombosis in many other vascular interventions (e.g. carotid or aortic stenting). The main problems of this dual antiplatelet therapy are the slow onset of action and the high interindividual variation in the degree of platelet inhibition. The thienopyridine prasugrel is a more potent platelet inhibitor with a more rapid onset of action and smaller interindividual variations in platelet inhibition. The therapeutic superiority of prasugrel was proven in patients with acute coronary syndrome undergoing coronary interventions. As a higher rate of bleeding complications was seen in patient subgroups further clinical studies with prasugrel are ongoing. Newer developments are focusing on ticagrelor, a new ADP-receptor antagonist, which has been proven superior to clopidogrel in clinical studies and triple therapy utilizing ASS, clopidogrel, and one of the new highly specific antithrombotics (e.g. factors Xa-antagonists or direct thrombin inhibitors).