A clinician's perspective of emerging P2Y(12)-directed pharmacotherapies, ex vivo measurement tools, and clinical outcomes.
Platelet-initiated acute thrombosis and coronary embolization are fundamental to the pathophysiology of acute coronary syndromes. Pharmacotherapies aimed at disrupting platelet function via the P2Y(12) receptor have been successful at reducing the incidence of vascular events in randomized clinical trials. However, with the emergence of third and fourth generation drugs, several important considerations remain, including metabolism, timing of onset, variability in platelet response or "resistance", monitoring ability, and off-target effects. These fundamental properties and distinct profiles may shape the future of cardiovascular therapeutics. Investigation of practical ex vivo platelet performance measurement tools is actively proceeding and may provide important information for patient management.
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