Abstract
Aspirin and clopidogrel are the most commonly used antiplatelet agents in patients with coronary artery disease. The existence of resistance to these agents has been a controversial issue and new drugs are being developed to overcome this problem. Laboratory tests, which can identify resistance and correlate this with clinical outcome, are being studied in order to identify patients at risk of future thrombotic events. We discuss the evidence for the existence of antiplatelet resistance-both in the laboratory and in the clinical setting. So far, platelet aggregometry has been considered the gold standard test, but is very operator dependant, time consuming, and has shown little correlation with other available tests of antiplatelet resistance. We discuss the available tests of platelet function, their limitations, and evidence for their use. A simple, rapid, near-patient test, which is affordable and useful in the clinical (not just laboratory) setting, could allow risk stratification of patients and individualization of antiplatelet medication to improve outcome.
Highlights
Platelets are the key players in pathological thrombus formation, that leads to myocardial infarction, ischaemic stroke, and peripheral vascular disease
We present the clinical evidence for the existence of antiplatelet resistance, describe the techniques used to date to identify antiplatelet resistance in the laboratory and their relative merits and shortcomings
Using light transmission aggregometry (LTA) to assess platelet reactivity and VASP to assess clopidogrel effect, the results suggested that high post treatment platelet reactivity and incomplete inhibition of P2Y12 are risk factors for stent thrombosis.[30]
Summary
Platelets are the key players in pathological thrombus formation, that leads to myocardial infarction, ischaemic stroke, and peripheral vascular disease. Reduction in platelet aggregation in response to high dose loading treatment with aspirin and clopidogrel was assessed in 60 patients presenting with acute ST
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