Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Glossary
- 1 The structure and production of blood platelets
- 2 Platelet immunology: structure, functions, and polymorphisms of membrane glycoproteins
- 3 Mechanisms of platelet activation
- 4 Platelet priming
- 5 Platelets and coagulation
- 6 Vessel wall-derived substances affecting platelets
- 7 Platelet–leukocyte–endothelium cross talk
- 8 Laboratory investigation of platelets
- 9 Clinical approach to the bleeding patient
- 10 Thrombocytopenia
- 11 Reactive and clonal thrombocytosis
- 12 Congenital disorders of platelet function
- 13 Acquired disorders of platelet function
- 14 Platelet transfusion therapy
- 15 Clinical approach to the patient with thrombosis
- 16 Pathophysiology of arterial thrombosis
- 17 Platelets and atherosclerosis
- 18 Platelets in other thrombotic conditions
- 19 Platelets in respiratory disorders and inflammatory conditions
- 20 Platelet pharmacology
- 21 Antiplatelet therapy versus other antithrombotic strategies
- 22 Laboratory monitoring of antiplatelet therapy
- 23 Antiplatelet therapies in cardiology
- 24 Antithrombotic therapy in cerebrovascular disease
- 25 Antiplatelet treatment in peripheral arterial disease
- 26 Antiplatelet treatment of venous thromboembolism
- Index
23 - Antiplatelet therapies in cardiology
Published online by Cambridge University Press: 15 October 2009
- Frontmatter
- Contents
- List of contributors
- Preface
- Glossary
- 1 The structure and production of blood platelets
- 2 Platelet immunology: structure, functions, and polymorphisms of membrane glycoproteins
- 3 Mechanisms of platelet activation
- 4 Platelet priming
- 5 Platelets and coagulation
- 6 Vessel wall-derived substances affecting platelets
- 7 Platelet–leukocyte–endothelium cross talk
- 8 Laboratory investigation of platelets
- 9 Clinical approach to the bleeding patient
- 10 Thrombocytopenia
- 11 Reactive and clonal thrombocytosis
- 12 Congenital disorders of platelet function
- 13 Acquired disorders of platelet function
- 14 Platelet transfusion therapy
- 15 Clinical approach to the patient with thrombosis
- 16 Pathophysiology of arterial thrombosis
- 17 Platelets and atherosclerosis
- 18 Platelets in other thrombotic conditions
- 19 Platelets in respiratory disorders and inflammatory conditions
- 20 Platelet pharmacology
- 21 Antiplatelet therapy versus other antithrombotic strategies
- 22 Laboratory monitoring of antiplatelet therapy
- 23 Antiplatelet therapies in cardiology
- 24 Antithrombotic therapy in cerebrovascular disease
- 25 Antiplatelet treatment in peripheral arterial disease
- 26 Antiplatelet treatment of venous thromboembolism
- Index
Summary
INTRODUCTION
Antiplatelet therapies are the mainstay in the treatment of acute coronary syndromes (ACSs) as well as in the chronic primary and secondary prevention of acute coronary events. This chapter describes the established antiplatelet agents in cardiology and introduces the novel drugs currently in advanced development.
ASPIRIN
Acetylsalicylic acid, known as aspirin, is an inhibitor of the production of prostaglandins and thromboxanes.
Mechanism of action
The prostaglandin (PG) endoperoxide H synthases-1 and -2, or cyclooxygenase (COX)-1 and -2, catalyze the conversion of arachidonic acid to PGH2, the first reaction of prostanoids synthesis. PGH2 is the immediate precursor of PGD2, PGE2, PGF2α, PGI2, and thromboxane (Tx) A2. Aspirin permanently inactivates COX-1 and COX-2. COX-1 is a constitutive enzyme of platelets and is 50- to 100-fold more sensitive to aspirin than COX-2 (which is predominantly expressed in response to inflammatory stimuli by monocytes/macrophages). Aspirin inhibits the synthesis of TxA2, a potent platelet-aggregating agonist and vasoconstrictor agent that is primarily produced by platelets from PGH2 and of PGI2 (prostacyclin), a platelet inhibitor and vasodilator agent that is produced by vascular endothelial cells. TxA2 is mainly produced by the COX-1 of platelets and therefore is most sensitive to the effect of aspirin, whereas PGI2 can be produced by both COX-1 and COX-2.
- Type
- Chapter
- Information
- Platelets in Hematologic and Cardiovascular DisordersA Clinical Handbook, pp. 407 - 436Publisher: Cambridge University PressPrint publication year: 2007