Antiplatelet agents: Is twice a day a better strategy?

Introduction: Although platelets have a special relevance in the formation and maintenance of thrombus that occurs after plaque rupture, a consensus has emerged that inflammation also plays a decisive role in the pathophysiology of these acute thrombotic events.Antiplatelet treatment is the "gold standard" for ACS.However, some patients develop recurrent CV events besides the antiplatelet treatment.Different hypothesis tried to explain these results, including genetic differences.But recently the relationship between platelet turn-over, a hyper-inflammatory status and prothrombotic risk are emerging.Areas covered: Inflammatory cytokines accelerate platelet daily turn-over and the release of an increased number of fresh immature platelets may not be effectively inhibited by the once-a-day administration of antiplatelet drugs.Young platelets appear to participate most actively in the thrombotic process.Expert opinion: Combination of antiplatelet drugs, more potent antiplatelet and higher doses proved to be not enough to reduce thrombotic events and they have increased the bleeding risk.Fragmented low doses of antiplatelet drugs during the day could be an alternative to evaluate according to some evidence.