Inhibitors of the platelet thrombin receptor: will they live up to their promises?

Not that long ago, aspirin, heparin, and warfarin were the only available antithrombotic agents for treating cardiovascular disease patients at risk of thrombotic events. These agents are still used in several places around the world, and it is remarkable how difficult it was to discover other agents that are more effective and/or safer. Since the mid-1980s we have been witnessing an explosion of research on new antithrombotic therapies, resulting in the availability of ticlopidine and clopidogrel (thienopyridine P2Y12-receptor inhibitors), low–molecular-weight heparins (eg, enoxaparin), and intravenous GPIIb/IIIa-receptor inhibitors (abciximab, eptifibatide, and tirofiban), later followed by fondaparinux (a synthetic indirect intravenous anti-Xa agent), bivalirudin (an intravenous direct anti-IIa agent), and more recently, prasugrel (a more potent thienopyridine) (Figure).