Semin Thromb Hemost 2005; 31(2): 174-183
DOI: 10.1055/s-2005-869523
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662.

Clopidogrel and Ticlopidine: P2Y12 Adenosine Diphosphate-Receptor Antagonists for the Prevention of Atherothrombosis

Pierre Savi1 , Jean-Marc Herbert1 , 2
  • 1Head, Biochemistry and Molecular Biology, Cardiovascular-Thrombosis Research Department, Sanofi-Aventis Recherche, Toulouse, France
  • 2Vice President Discovery Research
Further Information

Publication History

Publication Date:
26 April 2005 (online)

ABSTRACT

Ticlopidine and clopidogrel belong to the same chemical family of thienopyridine adenosine diphosphate (ADP)-receptor antagonists. They have shown their efficacy as platelet antiaggregant and antithrombotic agents in many animal models, both ex vivo and in vivo. Although ticlopidine was discovered more than 30 years ago, it was only recently that the mechanism of action of ADP-receptor antagonists was characterized in detail. Ticlopidine and clopidogrel both behave in vivo as specific antagonists of P2Y12, one of the ADP receptors on platelets. Metabolic steps that involve cytochrome P450-dependent pathways are required to generate the active metabolite responsible for this in vivo activity. The active moiety is a reactive thiol derivative that targets P2Y12 on platelets. The interaction is irreversible, accounting for the observation that platelets are definitely antiaggregated, even if no active metabolite is detectable in plasma. The interaction is specific for P2Y12; other purinoceptors such as P2Y1 and P2Y13 are spared. This results in inhibition of the binding of the P2Y12 agonist 2-methylthio-ADP and the ADP-induced downregulation of adenylyl cyclase. Platelet aggregation is affected not only when triggered by ADP but also by aggregation inducers when used at concentrations requiring released ADP as an amplifier. The efficacy and safety of clopidogrel has been established in several large, randomized, controlled trials. The clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE) trial demonstrated the superiority of clopidogrel over acetylsalicylic acid (ASA) in patients at risk of ischemic events, including ischemic stroke, myocardial infarction (MI), and peripheral arterial disease. The clopidogrel in unstable angina to prevent recurrent ischemic events (CURE) trial showed a sustained, incremental benefit when clopidogrel was added to standard therapy (including ASA) in patients with unstable angina and non-Q-wave MI. The clopidogrel for the reduction of events during observation (CREDO) trial demonstrated the benefit of continuing clopidogrel (plus ASA) for 12 months, as opposed to 1 month, after percutaneous coronary intervention. The proven efficacy of clopidogrel, coupled with its favorable safety and tolerability profile, has prompted its evaluation in an extensive, ongoing clinical trial program that will help to further characterize the benefit of clopidogrel in patients with a range of atherothrombotic profiles.

REFERENCES

 Dr.
J. M Herbert

Sanofi-Aventis Recherche, Cardiovascular-Thrombosis Research Department, 195 Route d’Espagne

31036 Toulouse Cedex, France

Email: jean-marc.herbert@sanofi-aventis.com

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