Platelet ADP P2Y₁₂ Inhibitors: Nonthienopyridines

Dual antiplatelet strategies have evolved beyond aspirin and clopidogrel to other novel antiplatelet agents. Ticagrelor is the first in a class of cyclopentyl-triazolo-pyrimidine (CPTP) drugs that are structurally derived as analogs of adenosine triphosphate (ATP). These drugs target inhibition of the ADP P2Y12 receptor at a different site and with a different mechanism from the thienopyridines. Clinical success in the DISPERSE-2 and PLATO trials has led to their FDA approval and recommendation by major medical societies for the management of acute coronary syndromes and percutaneous coronary interventions. Cangrelor is structurally similar to ticagrelor but is administered intravenously. Though clinical trials, such as CHAMPION-PLATFORM and CHAMPION-PCI, have been disappointing, this drug continues to be studied as a possible antiplatelet bridging therapy after coronary angiography and prior to performing coronary artery bypass graft surgery. Other novel antiplatelet agents under investigation will also be briefly summarized.