Diferencias en los mecanismos de acción de los nuevos antiagregantes: ¿cómo actúan?

Conventional treatment with aspirin and the thienopyridine clopidogrel has been superseded by the introduction of novel P2Y12 receptor blockers such as prasugrel and ticagrelor. Prasugrel, like all thienopyridines, is administered orally and is an irreversible inhibitor of the receptor. Despite being a prodrug, prasugrel is metabolized more rapidly and effectively than clopidogrel and consequently offers a greater clinical benefit. Ticagrelor is a nucleoside analog that reversibly blocks the receptor and does not require hepatic bioactivation, which makes it a rapid and potent platelet inhibitor. In addition, two other compounds under investigation -cangrelor and elinogrel- are available in intravenous formulations. They have a direct, reversible effect on the P2Y12 receptor and appear to have a better safety profile in patients undergoing coronary surgery. In recent years, all these compounds, and in particular ticagrelor, have been shown to have other clinical benefits in addition to platelet inhibition - their so-called pleiotropic effects.