Novel Antiplatelet Agents: The Current State and What Is Coming Down the Pike

Antiplatelet therapy is the cornerstone of treatment for patients with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). Despite the use of dual antiplatelet therapy with aspirin and clopidogrel, a considerable number of patients still experience atherothrombotic events, which may be explained at least in part by inadequate platelet inhibition induced by this treatment regimen. This underscores the need for more potent antithrombotic strategies for the acute and long-term treatment of ischemic complications, especially in high-risk patients. These include novel generation P2Y12 receptor antagonists, such as prasugrel, ticagrelor and cangrelor, or adjunctive antiplatelet agents targeting different pathways, such as the thrombin protease-activated receptors-1 receptor inhibitor vorapaxar. Moreover, since ischemic events accrue over time after an acute event, prolonging intensified antiplatelet therapy beyond 1-year has also been investigated. This manuscript provides an overview on the current status and future directions of antithrombotic therapies for the treatment of patients with ACS or treated with PCI, mainly focusing on novel agents.