European Heart Journal Advance Access originally published online on December 19, 2005
European Heart Journal 2006 27(6):647-654; doi:10.1093/eurheartj/ehi684
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Aspirin and clopidogrel resistance: an emerging clinical entity
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F25, Cleveland, OH 44195, USA
Received 14 July 2005; revised 26 October 2005; accepted 24 November 2005; online publish-ahead-of-print 19 December 2005.
* Corresponding author. Tel: +1 216 445 4042; fax: +1 216 445 8531. E-mail address: bhattd{at}ccf.org
Antiplatelet therapy is a cornerstone of cardiovascular medicine. Aspirin and clopidogrel have emerged as critical therapies in the treatment of cardiovascular disease. Despite their efficacy, patients on these medications continue to suffer complications. Millions of patients are currently on low-dose antiplatelet therapy but it is unknown how many of these patients are under-treated or on the wrong medication. Aspirin and clopidogrel resistance are emerging clinical entities with potentially severe consequences such as recurrent myocardial infarction, stroke, or death. The mechanism of resistance remains incompletely defined, but there are specific clinical, cellular, and genetic factors that influence therapeutic failure. These factors range from physicians who fail to prescribe these medications despite appropriate indications to polymorphisms of platelet membrane glycoproteins. Rapid and accurate diagnosis of antiplatelet resistance also remains an issue as new bedside tests are developed. By understanding the mechanism of therapeutic failure and by improving the diagnosis of this clinical entity, a new era of individualized antiplatelet therapy may arise with routine measurements of platelet activity in the same way that cholesterol, blood pressure, and blood sugar are followed, thus improving the care for millions of people.
Key Words: Aspirin • Clopidogrel • Aspirin resistance • Clopidogrel resistance
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