The FDA approved the third thienopyridine agent, prasugrel (Effient, Eli Lilly/Daiichi Sankyo), in July 2009, challenging the U.S. market dominance of clopidogrel (Plavix, Bristol Myers Squibb/Sanofi Aventis). Yet, some cardiologists are being cautious about rapid, widespread adoption, and uptake has been slower than expected. Meanwhile, other optionssuch as reversible agentsloom on the horizon.