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. 2010 Jul 26;2(7):171-86.
doi: 10.4330/wjc.v2.i7.171.

Clinical importance of aspirin and clopidogrel resistance

Gergely Feher  1 , Andrea Feher, Gabriella Pusch, Katalin Koltai, Antal Tibold, Beata Gasztonyi, Elod Papp, Laszlo Szapary, Gabor Kesmarky, Kalman Toth
Affiliations
Free PMC article

Clinical importance of aspirin and clopidogrel resistance

Gergely Feher et al. World J Cardiol. .
Free PMC article

Abstract

Aspirin and clopidogrel are important components of medical therapy for patients with acute coronary syndromes, for those who received coronary artery stents and in the secondary prevention of ischaemic stroke. Despite their use, a significant number of patients experience recurrent adverse ischaemic events. Interindividual variability of platelet aggregation in response to these antiplatelet agents may be an explanation for some of these recurrent events, and small trials have linked "aspirin and/or clopidogrel resistance", as measured by platelet function tests, to adverse events. We systematically reviewed all available evidence on the prevalence of aspirin/clopidogrel resistance, their possible risk factors and their association with clinical outcomes. We also identified articles showing possible treatments. After analyzing the data on different laboratory methods, we found that aspirin/clopidogrel resistance seems to be associated with poor clinical outcomes and there is currently no standardized or widely accepted definition of clopidogrel resistance. Therefore, we conclude that specific treatment recommendations are not established for patients who exhibit high platelet reactivity during aspirin/clopidogrel therapy or who have poor platelet inhibition by clopidogrel.

Keywords: Antiplatelet agent; Aspirin; Aspirin resistance; Cardiovascular outcome; Clopidogrel; Clopidogrel resistance; Platelet aggregation.

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Figures

Figure 1
Figure 1
Pathways of platelet activation and mechanism of action of antiplatelet agents[2]. COX: Cyclooxygenase; GP: Glycoprotein; TxA2: Thromboxane A2; ASA: Acetylsalicylic acid; NSAIDs: Nonsteroidal anti-inflammatory drugs; PAF: Platelet-activating factor.
Figure 2
Figure 2
The clinical importance of aspirin resistance[30].
Figure 3
Figure 3
The possible background of aspirin resistance[38]. COX: Cyclooxygenase.
Figure 4
Figure 4
Possible genetical background of clopidogrel resistance[82]. GP: Glycoprotein.
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