[Present and future developments of antithrombotic agents].

Abstract

The search for the optimal antithrombotic efficacy to bleeding risk ratio in interventional cardiology has promoted the development of new antithrombotics and to the elaboration of new association strategies. The relatively modest and inconstant antiaggregant effect of 300 mg of clopidogrel has led to the use of higher dosages of 600 mg or 900 mg. The improved biological effects justify clinical evaluation on a larger scale. While waiting for the results of the CHARISMA trial, several studies seem to demonstrate the benefits of long-term administration. New thienopyridines, the leader of which is prasugrel, have powerful biological effects and have already been assessed in larger clinical trials. The anti GPIIb/IIIa molecules, the indications of which have been recently redefined, feature in new administration strategies under evaluation. The use of direct or indirect thrombin antagonists during invasive procedures remains necessary and several molecules are candidates for replacing unfractionated heparin, with a more predictable activity. Low molecule weight heparins have been shown to be easier to use compared with unfractionated heparin. Synthetic factor Xa inhibitors are at an early stage of development. Of the direct thrombin antagonists, bivalirudine provides an improved benefit/risk ratio and is a new option in the catheter laboratory.