Aspirin and clopidogrel resistance: should we worry about?

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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

T Cuisset1, G Cayla

  • 1Department of Cardiology, University Hospital of Marseille, Marseille, France. thomascuisset@voila.fr

Minerva Medica
|March 16, 2010
PubMed

Insights

Aspirin and clopidogrel resistance, defined by poor drug effect on platelets, is linked to worse outcomes in coronary artery disease. New drugs may offer more predictable antiplatelet inhibition.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Antiplatelet therapy, particularly aspirin and clopidogrel, is crucial for managing coronary artery disease (CAD), acute coronary syndrome (ACS), and post-stent placement.
  • Despite established efficacy, recurrent cardiovascular events persist, with drug resistance emerging as a significant contributing factor.
  • Aspirin and clopidogrel resistance is characterized by an inadequate antiplatelet response, impacting treatment effectiveness.

Purpose of the Study:

  • To review the biological and clinical evidence surrounding resistance to aspirin and clopidogrel therapy.
  • To explore the complex and not fully understood mechanisms underlying variable responses to antiplatelet agents.
  • To assess the potential impact of antiplatelet resistance and emerging therapies on clinical practice.

Main Methods:

  • Literature review of biological studies defining antiplatelet resistance using platelet function tests.
  • Analysis of clinical studies correlating antiplatelet resistance with patient outcomes.
  • Examination of proposed tailored therapeutic strategies based on platelet function testing.
  • Consideration of novel antiplatelet agents and their potential to achieve uniform platelet inhibition.

Main Results:

  • Resistance to aspirin and clopidogrel is a recognized phenomenon, primarily defined by impaired platelet inhibition.
  • Clinical studies suggest a link between biological resistance and adverse clinical outcomes in patients with CAD.
  • The mechanisms driving this resistance are complex and require further elucidation.
  • Personalized antiplatelet therapy guided by platelet function tests has been proposed as a clinical strategy.

Conclusions:

  • Understanding antiplatelet resistance is vital for optimizing treatment in patients with coronary artery disease.
  • Emerging antiplatelet drugs may offer more consistent platelet inhibition, potentially mitigating resistance issues.
  • Clinical practice may evolve towards more individualized antiplatelet regimens based on patient response and novel therapeutic options.

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