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Platelet resistance to antiplatelet drugs
1Cardiac Catheterization Laboratory, Section of Cardiology, Jesse Brown VA Medical Center, University of Illinois at Chicago, Illinois, USA.
Insights
Dual antiplatelet therapy is standard for cardiovascular disease, but some patients show resistance. Understanding antiplatelet drug resistance is key to preventing recurrent cardiovascular events.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis
Background:
- Platelet aggregation is crucial in cardiovascular diseases.
- Dual antiplatelet therapy (aspirin and clopidogrel) is standard for acute coronary syndrome and percutaneous coronary intervention.
- Recurrent cardiovascular events occur despite dual antiplatelet therapy in some patients.
Purpose of the Study:
- To review the mechanisms, clinical relevance, and evaluation methods of antiplatelet drug resistance.
- To discuss controversies in defining antiplatelet drug resistance.
- To explore current and future management strategies for antiplatelet drug resistance.
Main Methods:
- Literature review of mechanisms, clinical relevance, and evaluation of antiplatelet drug resistance.
- Analysis of evidence supporting the association between enhanced platelet reactivity and adverse cardiovascular outcomes.
- Examination of recent patents and therapeutic directions.
Main Results:
- Enhanced platelet reactivity despite dual antiplatelet therapy (antiplatelet drug resistance) is linked to poor outcomes.
- Mechanisms of antiplatelet drug resistance are multifactorial and not fully understood.
- A precise definition for antiplatelet drug resistance is still lacking.
Conclusions:
- Antiplatelet drug resistance poses a significant clinical challenge in cardiovascular disease management.
- Further research into mechanisms and standardized definitions is needed.
- Novel therapeutic strategies are being explored to overcome antiplatelet drug resistance and improve patient outcomes.
Abstract:
In patients with cardiovascular diseases, platelet aggregation plays an important role in development of cardiovascular events and hence its inhibition is important in prevention and treatment of these events. Antiplatelet therapy is the cornerstone of treatment for patients with acute coronary syndrome and in those who undergo percutaneous coronary intervention. Currently dual antiplatelet therapy with aspirin and clopidogrel is the standard of care in such patients and has been associated with improved cardiovascular outcomes. However, a significant number of patients experience recurrent cardiovascular events despite being on dual antiplatelet therapy. At present there is growing evidence that these events may be associated with poor response to these antiplatelet drugs and has been commonly called as antiplatelet drug resistance. The exact mechanisms leading to antiplatelet drug resistance are not very well understood but are likely multifactorial. Although the precise definition of antiplatelet drug resistance is lacking, but there is sufficient evidence to support that persistence of enhanced platelet reactivity persists despite use of aspirin and clopidogrel and is associated with adverse cardiovascular outcomes. In this paper, we will review the mechanisms, clinical relevance, methods to evaluate, controversies surrounding the definition along with some recent patents and current and future directions for management of antiplatelet drug resistance.
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