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• W2076403707 abstract "La plaqueta ha asumido un papel preponderante en la medicina cardiovascular gracias a la comprensión del syndrome coronario agudo (SCA) como un proceso aterotrombótico. Esto ha establecido el uso generalizado de agentes antiplaquetarios, como la aspirina, las tienopiridinas y los antagonistas de los receptores de la glucoproteína IIb/IIIa, en la prevención de las enfermedades isquémicas coronarias. Sin embargo, hay evidencias recientes de que no todos los pacientes reciben el tratamiento antiplaquetario adecuado, ya sea por el fenómeno de la «resistencia » o «respuesta variable» al fármaco o por un aumento en el riesgo de sangrado. Es más, la falta de eficacia de la combinación aspirina-clopidogrel en la prevención primaria ha cuestionado el concepto de «a mayor inhibición, mayor eficacia». Actualmente, los esfuerzos se centran en la mejora de los tratamientos antiplaquetarios en uso a fin de mejorar su efectividad y su seguridad. Se están desarrollando antagonistas alternativos de los receptors del ADP (prasugrel, AZD6140 y cangrelor) y de la trombina (E555 y SCH530348) que podrían ofrecer más inhibición de las plaquetas, más rápida y constante. Asimismo, el avance en el conocimiento de la estructura de la plaqueta y los mecanismos implicados en la formación del trombo puede dar lugar al descubrimiento de nuevas dianas terapéuticas. Este artículo revisa el papel fisiopatológico de las plaquetas en el proceso aterotrombótico, evalúa lo más actual del arsenal antiplaquetario actualmente en uso y comenta nuevas aproximaciones terapéuticas. Platelets are now regarded as playing a dominant role in cardiovascular medicine since our recent understanding of acute coronary syndrome as an atherothrombotic process. This development has led to the widespread use of antiplatelet agents, such as aspirin, thienopyridines and glycoprotein-IIb/IIIa receptor blockers, for the prevention of ischemic heart disease. Nevertheless, recent evidence suggests that not all patients receive appropriate antiplatelet therapy because there may be resistance or a variable response to the drug used or because of an increased risk of hemorrhage. Moreover, the reported lack of efficacy of the combination of clopidogrel and aspirin when used for primary prevention has raised concerns about the general concept that greater inhibition implies greater efficacy. At present, research efforts are focused on improving current antiplatelet treatment with the aim of increasing efficacy and safety. Alternative ADP-receptor antagonists (e.g., prasugrel, cangrelor and AZD6140) and thrombin-receptor antagonists (e.g., E5555 and SCH 530348) are being developed. They may provide faster, more potent and more stable platelet inhibition. In addition, new insights into platelet structure and into the mechanisms underlying thrombus formation could lead to the discovery of new therapeutic targets. This article reviews what is known about the pathophysiological role of platelets in the atherothrombotic process, considers the current state of the art in antiplatelet therapy, and provides a commentary on new therapeutic approaches." @default.
• W2076403707 created "2016-06-24" @default.
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• W2076403707 date "2008-05-01" @default.
• W2076403707 modified "2023-10-04" @default.
• W2076403707 title "Enfermedad aterotrombótica coronaria: avances en el tratamiento antiplaquetario" @default.
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• W2076403707 doi "https://doi.org/10.1157/13119995" @default.
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