ANTIPLATELET THERAPY IN CLINICAL PRACTICE

Antiplatelet agents have a powerful effect on subacute thrombosis after the placement of coronary stents. As adjunctive therapy to stent placement, they assist in the prevention of restenosis. Some clinicians are of the opinion that in a few years' time, antiplatelet agents will displace stenting and coronary angioplasty as the intervention of choice for coronary stenosis. The editors have assembled a great team of clinicians and researchers who are all experts with antiplatelet agents. This book is a practical and essential guide for all those working in interventional cardiology.

At one time, antiplatelet therapy was limited to aspirin and dipyridamole as secondary or primary preventive agents. Today, however, we are facing a dramatic revolution in this field with the rapid development of receptor antagonists, inhibitors of platelet adhesion, and metabolic inhibitors.

Antiplatelet Therapy in Clinical Practice attempts to introduce this revolution to physicians practicing primarily in the field of cardiovascular medicine. The list of contributors illustrates that many specialists in this discipline are now also platelet experts. The book has four sections: an introduction to coagulation and platelet function, a section on the various antiplatelet agents, a section on clinical applications, and a section devoted to future directions.

The first section could be helpful to readers who wish to refresh their knowledge before moving to the main sections on antiplatelet agents and clinical applications. However, each of the subsequent sections covers basic principles, and readers can thus avoid referring to the introduction.

The section on antiplatelet agents introduces the reader to the mechanisms of action of the different classes of these drugs: aspirin and dipyridamole; the adenosine diphosphate-receptor blockers ticlopidine and clopidogrel; abciximab, the antibody against the integrin complex glycoprotein IIb/IIIa on platelets that binds to fibrinogen; peptide and nonpeptide inhibitors of platelet glycoprotein IIb/IIIa receptors; and some new compounds that are still in the developmental stage.

The chapter on agents that block adenosine diphosphate receptors (ticlopidine and clopidogrel) is of great interest. Although these agents have been in clinical use for several years, their specific mode of action is not yet completely understood. This section includes a brief review of the clinical trials of these drugs, and detailed summaries of all these trials can be found in the next section.

The section on clinical applications is a systemic discussion of each of the relevant clinical entities, including peripheral vascular diseases, atrial fibrillation, interventional cardiology, and acute coronary syndromes. Each chapter begins with a description of the specific clinical entity, followed by a detailed review of the clinical applications of the various agents. These comprehensive reviews also cover other parts of treatment, such as thrombolytic therapy and anticoagulant therapy. The authors have limited their conclusions to subjects that are already resolved, and they do not provide answers to questions that are still under investigation, such as the safety of new drugs and of long-term oral therapy with antagonists of platelet glycoprotein IIb/IIIa receptors.

The book documents the rapid growth in the field of antiplatelet therapy and is a wonderful source of related references. I warmly recommend it to physicians in the field of cardiovascular medicine and to those interested in developments in drug research.

David Varon, M.D.
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