Classification of Antiplatelet Agents

Based on their mechanism of action, the Antiplatelet Agents could be classified as follows:

Aspirin is an irreversible cyclooxygenase inhibitor (inhibition of COX-1 and

COX-2 activity).

Triflusal (Disgren®) is a salicylate, which blocks cyclooxygenase and phosphodiesterase

and also preserves vascular prostacyclin.

Adenosine diphosphate (ADP) receptor inhibitors block P2Y12 component

of ADP receptor on platelet surface (including clopidogrel “Plavix®,” prasugrel

“Effient®,” ticagrelor “Brilinta®,” and ticlopidine “Ticlid®”).

Phosphodiesterase inhibitors increase plasma level of cellular cAMP and

block platelet aggregation in response to ADP like cilostazol (Pletal®) which is a

selective phosphodiesterase 3 inhibitor or dipyridamole “Persantine®” which

is both a phosphodiesterase 5 inhibitor and an adenosine deaminase inhibitor.

Glycoprotein IIB/IIIA inhibitors including abciximab “ReoPro®,” eptifibatide

“Integrilin®,” and tirofiban “Aggrastat®.” These agents are only available in

intravenous formulations.

Protease-activated receptor-1 (PAR-1) antagonists, mainly vorapaxar

“Zontivity®,” block thrombin-responsive receptors in platelets and prevent

thrombin generation

Thromboxane inhibitors including thromboxane synthase inhibitors and thromboxane

receptor antagonists like terutroban.