[Historical and future perspective of antithrombotic agents]

Antithrombotic agents including antiplatelet and anticoagulant ones are effective in prevention of thrombotic diseases such as myocardial infarction, ischemic stroke, and venous thrombosis. Aspirin is the most commonly used antiplatelet agent, which has strong evidence to prevent cardiovascular death in patients with acute myocardial infarction. Clopidogrel is also commonly used antiplatelet agents, which is now known to block P2Y12 ADP receptor. New generation of P2Y12 ADP antagonists including prasugrel and ticagrelor are available, but only in patients with acute coronary syndrome. We have used warfarin for more than 50 years. Warfarin is a potent anticoagulant agent to prevent functional completion of vitamin K dependent coagulant factors. New generation of oral anticoagulants were developed, but some were shown not to strong enough in prevention of thrombotic complication in patients with artificial valve. All antithrombotic agents have limitations. Most important limitation is to increase the incidence of serious bleeding complication. Future progress of our understanding for the mechanisms of the onset of thrombotic diseases is essentially important to develop better antithrombotic agents.