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Thienopyridines in cardiovascular disease: focus on clopidogrel resistance

Jolanta Siller-Matula1, Karsten Schrör, Johann Wojta

  • 13rd Department of Medicine, Cardiology and Emergency Medicine, Wilhelminenhospital, Montleartstrasse 37, A-1160 Vienna, Austria. kurt.huber@wienkav.at

Thrombosis and Haemostasis
|March 6, 2007
PubMed

Insights

Clopidogrel resistance reduces treatment effectiveness for atherothrombotic diseases. Developing rapid point-of-care tests is crucial for identifying non-responders and guiding alternative antiplatelet therapies.

Area of Science:

  • Cardiology
  • Pharmacology
  • Hematology

Background:

  • Platelets are key in atherothrombotic disease and atherosclerosis complications.
  • Clopidogrel, an antiplatelet drug, is vital for treating coronary artery disease (CAD), acute coronary syndromes (ACS), and post-coronary interventions.
  • Clopidogrel inhibits the P2Y(12) receptor, offering potent antithrombotic activity.

Purpose of the Study:

  • To address the challenge of clopidogrel resistance, where patients show decreased platelet responsiveness.
  • To highlight the need for a fast, bedside assay to detect clopidogrel resistance early.
  • To discuss the development of alternative antithrombotic strategies for non-responders.

Main Methods:

  • Review of emerging data on clopidogrel resistance mechanisms.
  • Discussion of the limitations of current diagnostic methods for clopidogrel responsiveness.
  • Exploration of new ADP receptor antagonists with improved pharmacokinetic profiles.

Main Results:

  • A significant percentage of patients exhibit decreased responsiveness to clopidogrel.
  • Current point-of-care tests for detecting clopidogrel resistance are unavailable.
  • New ADP receptor antagonists, like prasugrel, are in development and clinical trials.

Conclusions:

  • Early detection of clopidogrel resistance is essential for optimizing antiplatelet therapy.
  • The development of a standardized, reproducible point-of-care assay is a critical unmet need.
  • Novel antiplatelet agents with improved pharmacokinetics offer promising alternatives for managing non-responders.

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