Intensifying Platelet Inhibition — Navigating between Scylla and Charybdis

In Greek mythology, Scylla was a ferocious beast and Charybdis was a monstrous whirlpool. The wily Odysseus successfully navigated between these two dangers by steering closer to Scylla, though he did lose a few crew members to her. In a similar manner, the astute clinician managing myocardial ischemia by using antiplatelet therapy attempts to balance coronary thrombosis, the basic cause of myocardial ischemia, against hemorrhage, the most-feared complication of antiplatelet therapy. There are many pathways by which antiplatelet drugs may antagonize platelet activation or aggregation, all of which increase the risk of bleeding, and many of which decrease the risk . . .