Intelligent platelet inhibitors are on the horizon.

Hemostasis is a tightly regulated physiological sequence of events that maintains vascular integrity and imminent blood loss after vessel injury. Platelets play a critical role in primary hemostasis and in regulation of coagulation. Under physiological conditions, hemostasis and thrombosis are in a fragile equilibrium. Uncontrolled platelet activation leads to intravascular thrombosis and organ failure. In patients with cardiovascular diseases such as coronary artery disease or stroke, antiplatelet therapy has substantially improved morbidity and mortality. To date, several antiplatelet inhibitors, including acetyl salicylic acid, P2Y12 inhibitors, and glycoprotein (GP) IIb-IIIa (integrin IIb 3) receptor blockers, are available to prevent or treat arterial thrombosis in affected patients.1 However, all current antiplatelet drugs inhibit both resting and activated platelets resulting in inhibition of hemostasis. Thus, current antiplatelet therapy is associated with enhanced risk of bleeding. Novel antiplatelet strategies are warranted to control undesired platelet activation without disrupting hemostasis and risking life-threatening bleeding complications.