[Desaggregant Therapy of Patients With Ischemic Heart Disease: Unsolved Problems]

Area of Science:

• Cardiology
• Pharmacology
• Thrombosis Research

Background:

• Current antiplatelet therapy for ischemic heart disease (IHD) choice is multifactorial but often lacks regular efficacy control.
• Standard antiplatelet regimens, including combinations with anticoagulants, show limited impact on mortality and increase bleeding risks.
• High residual platelet reactivity (RPR) is linked to poor prognosis in arterial thrombosis.

Purpose of the Study:

• To investigate the impact of antiplatelet drug selection based on platelet reactivity.
• To explore strategies for overcoming high RPR in IHD patients.
• To evaluate alternative therapeutic approaches for improved long-term outcomes.

Main Methods:

• Analysis of antiplatelet drug efficacy in IHD patients.
• Assessment of residual platelet reactivity (RPR) during monotherapy and combination therapy.
• Comparison of outcomes with different antiplatelet strategies, including aspirin, clopidogrel, and oral anticoagulants.

Main Results:

• Switching antiplatelet agents (aspirin/clopidogrel) or using them in combination can address high RPR.
• Combination therapy showed only a slight increase in achieving target platelet reactivity in patients with high RPR on monotherapy.
• Current combination therapies with oral anticoagulants do not significantly reduce mortality but increase bleeding risk.

Conclusions:

• Individualized antiplatelet therapy selection based on RPR is a promising approach for IHD.
• Further research into combining clopidogrel with oral anticoagulants like rivaroxaban may benefit specific patient groups with high RPR.
• New strategies are needed to improve long-term outcomes in IHD patients undergoing antiplatelet therapy.