Resumen
Las tienopiridnas son anitiagregantes plaquetarios con una efectividad igual o superior a la del ASA (ácido acetil- salílico), son metabolizadas en el hígado a través del sistema de la Citocromo P-450, lo cual puede determinar la resistencia a su efecto e interacciones cuestionadas con algunos inhibidores de la bomba de protones. La ticlopidina fue la la primera molécula de esta familia y se usó ampliamente hasta finales de los noventa. Fue remplazada por el clopidogrel el cual es 100 veces más potente. En la enfermedad coronaria se usa el clopidogrel en combinación con el ASA tanto en el evento agudo como luego de la angioplastia, en la enfermedad cerebrovascular por el con- trario el uso de la terapia dual no ha demostrado ser efectivo y conlleva un incremento en las tasas de sangrado. Actualmente hay estudios en curso para la administración de terapia dual en pacientes con ACV isquémico agudo, igualmente está en cursootro estudio en prevención secundaria del ACV isquémico con terapia dual. Su mecanismo de acción es sobre el receptor P2Y (12), el cual es el principal receptor en la agregación plaquetaria mediada por ADP, lo bloquean en forma indirecta a través de sus tiolactonas, las cuales se unen covalentemente a este en forma irreversible generando antiagregación plaquetaria. Este receptor es en la actualidad el centro de investigación en la generación de nuevos fármacos que modulan la agregación plaquetaria, en forma tanto indirecta (Tienopiridinas) como directa, ticagrelor de uso oral y cangrelor de uso I.V.
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