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Resistance to antiplatelet therapy
Sasidhar Guthikonda1, Eli I Lev, Neal S Kleiman
1Baylor College of Medicine, 6565 Fannin, MS F1090, Houston, TX 77030, USA.
Insights
High cardiovascular events occur despite antiplatelet drugs like aspirin and clopidogrel. Patient resistance to these drugs, termed aspirin resistance and clopidogrel resistance, is common and requires further research.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Cardiovascular mortality remains high in patients using antiplatelet medications.
- Aspirin and clopidogrel are standard treatments for coronary artery disease and post-percutaneous angioplasty.
- Patient response to aspirin and clopidogrel is variable, leading to resistance.
Purpose of the Study:
- To highlight the clinical significance of aspirin resistance and clopidogrel resistance.
- To explore the postulated mechanisms behind these resistance phenomena.
- To identify the need for further research into testing and treatment strategies.
Main Methods:
- Review of existing literature on antiplatelet therapy and resistance.
- Discussion of potential genetic, pharmacokinetic, and platelet property alterations.
- Identification of knowledge gaps in clinical significance, testing, and treatment.
Main Results:
- Diminished or absent platelet response to aspirin and clopidogrel, termed resistance, affects over 50% of patients.
- Mechanisms of resistance may involve genetic, pharmacokinetic, and platelet factors.
- Limited information exists regarding the clinical impact and management of resistance.
Conclusions:
- Aspirin and clopidogrel resistance are significant clinical issues with high prevalence.
- Further research is crucial to understand the clinical significance, develop diagnostic methods, and establish effective treatment strategies.
- Identifying and managing patients with resistance is essential for improving cardiovascular outcomes.
Abstract:
Cardiovascular mortality continues to be high and events continue to occur in patients taking antiplatelet medications. Aspirin and clopidogrel have become integral parts of management in patients with coronary artery disease and after percutaneous angioplasty. However, the platelet responses to aspirin and clopidogrel are not uniform. Diminished or lack of response to these agents has been termed aspirin resistance and clopidogrel resistance. These phenomena have tremendous clinical significance as together they may occur in more than 50% of all patients on chronic therapy with aspirin or clopidogrel. Postulated mechanisms of aspirin and clopidogrel resistance include alterations in genetic, pharmacokinetic, and platelet properties. There is a dearth of information in regard to their clinical significance, methods to test them, and strategies to treat them. Further research is necessary in these areas to identify these patients and treat them appropriately.
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