Adenosine Diphosphate Inhibitors

Clopidogrel, Prasugrel and Ticlopidine

Mechanism of action
These agents irreversibly block the ADP receptor on platelets,
thus reducing platelet aggregation. Antiplatelet effects persist
for the life of the platelet.
Clinical use
Currently, ADP inhibitors are considered the main alternatives
to aspirin for preventing thrombotic events in atherogenic
patients with recent myocardial infarctions, strokes,
transient ischemic attack, and unstable angina.
Adverse effects
Similar to other antiplatelet agents, ADP inhibitors increase
the risk of bleeding. Clopidogrel is preferred over ticlopidine
because of life-threatening hematologic reactions associated
with ticlopidine, including neutropenia/agranulocytosis and
thrombotic thrombocytopenic purpura. Clopidogrel is a prodrug
that must be activated by cytochrome P450 ZC19. Genetic
polymorphisms in ZC19 or drugs that inhibit its
activity can decrease clopidogrels efficacy. Prasugrel has
the advantage that it is not a prodrug and its antiplatelet effects
are independent of CYP450 activity