[Is antiplatelet therapy always effective?]

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Antiplatelet therapy with acetylsalicylic acid (ASA) and clopidogrel (KLP) exhibits significant inter-individual response variability.
• A subset of patients demonstrates resistance to standard antiplatelet drug regimens.
• Optimizing antiplatelet therapy is crucial for high-risk cardiovascular event patients.

Purpose of the Study:

• To evaluate individual patient responses to antiplatelet therapy.
• To assess treatment efficacy in patients receiving ASA, KLP, or combination therapy.
• To identify predictors of response and resistance in cardiovascular patients.

Main Methods:

• Light transmission aggregometry was employed to measure platelet aggregation.
• VASP phosphorylation analysis was conducted in a subset of patients.
• Patient cohorts included those treated with ASA (n=131), KLP (n=51), or ASA + KLP (n=34).

Main Results:

• Good response to ASA (inhibition < 20%) was observed in 75.0% of patients; poor response (>40%) in 12.1%.
• Good response to KLP (inhibition < 60%) was achieved by 66.1%; poor response (>70%) in 20%.
• Dose adjustments (e.g., increasing KLP to 150 mg) improved response in non-responders; higher ASA doses (>100 mg) showed limited benefit.

Conclusions:

• Laboratory monitoring of individual antiplatelet response enables personalized therapy optimization.
• This monitoring can identify patients suitable for alternative antiplatelet agents like prasugrel and ticagrelor.
• Tailoring antiplatelet therapy based on individual response improves clinical outcomes in high-risk patients.