Individual Variability of Response to Antiplatelet Therapy is an Important Determinant of Adverse Clinical Outcome

Abstract

Dual antiplatelet therapy with aspirin (acetylsalicylic acid) and clopidogrel is widely used in order to prevent recurrent ischaemic events in patients undergoing percutaneous coronary intervention. The goal is to achieve an optimal platelet inhibition, providing clear clinical benefit in most patients. However, a wide inter-individual variability exists in the response to antiplatelet drugs. Several factors, such as genetic, cellular and clinical factors, may contribute to determine fluctuation in platelet reactivity even within the individual patient. Patients with high post-treatment platelet reactivity are at higher risk of ischaemic events in both the short term (during or shortly after percutaneous coronary intervention) and the long term. Several methodologies and devices have been developed to monitor individual response to antiplatelet treatment assessing different pathways of platelet activation and aggregation. In these patients, more aggressive antithrombotic strategies and new generation drugs may be beneficial in order to reduce ischaemic complications after percutaneous coronary intervention.