[Study of variability in response to aspirin and clopidogrel: clinical and/or biological resistance?]

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Aspirin and clopidogrel are widely used long-term antiplatelet therapies in France.
• These drugs are crucial for secondary prevention following arterial thrombotic events like myocardial infarction and stroke.
• The concept of 'resistance' to these drugs is often ambiguously defined and applied.

Purpose of the Study:

• To address the confusion surrounding the term 'resistance' in antiplatelet therapy.
• To advocate for the adoption of 'variable platelet response' as a more accurate and accepted term.
• To explore the clinical relevance of differentiating between true resistance and variable response.

Main Methods:

• Review of existing biological and clinical literature on antiplatelet drug response.
• Discussion of various platelet function tests used to assess treatment impact.
• Consideration of ongoing large-scale prospective studies.

Main Results:

• True pharmacological resistance to aspirin and clopidogrel is considered rare.
• A variable platelet response is a more common phenomenon observed in patients.
• Distinguishing between resistance and variable response may have significant prognostic implications.

Conclusions:

• The term 'variable platelet response' is preferred over 'resistance' for better clarity and acceptance among specialists.
• Platelet function tests are valuable tools for evaluating the biological effects of antiplatelet treatments.
• Further research and results from ongoing studies are necessary to establish clinical guidelines for optimal antiplatelet therapy based on response variability.