The present state of aspirin and clopidogrel resistance

Area of Science:

• Cardiology
• Pharmacology
• Hematology

Background:

• Antiplatelet therapy is crucial for acute coronary syndrome (ACS) but does not prevent all cardiovascular events.
• Platelet physiology is complex, contributing to arterial thrombosis despite treatment.
• The emergence of diagnostic tests aims to personalize antiplatelet treatment strategies.

Purpose of the Study:

• To investigate the concept of "resistance" to common antiplatelet agents, specifically aspirin and clopidogrel.
• To critically evaluate the clinical data suggesting suboptimal patient response to these drugs.
• To differentiate true pharmacological resistance from other measures of platelet activity.

Main Methods:

• Review of clinical data and studies examining antiplatelet therapy response.
• Analysis of diagnostic testing platforms used to assess platelet function.
• Comparison of measured platelet parameters with the therapeutic targets of aspirin and clopidogrel.

Main Results:

• Clinical data indicate a significant incidence of suboptimal response to aspirin and clopidogrel.
• The term "resistance" is frequently applied, but its definition varies across studies.
• Many tests used to define resistance measure platelet activation/aggregation, not necessarily a lack of drug effect.

Conclusions:

• The definition and measurement of "resistance" to antiplatelet drugs require careful consideration.
• Current testing methods may not accurately capture true pharmacological resistance to aspirin and clopidogrel.
• Further research is needed to refine the understanding and clinical application of antiplatelet drug resistance in ACS.