European Heart Journal Advance Access published online on January 27, 2009
European Heart Journal, doi:10.1093/eurheartj/ehn562
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Interindividual variability in the response to oral antiplatelet drugs: a position paper of the Working Group on antiplatelet drugs resistance appointed by the Section of Cardiovascular Interventions of the Polish Cardiac Society, endorsed by the Working Group on Thrombosis of the European Society of Cardiology
1 3rd Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
2 Institute of Cardiology, Warsaw, Poland
3 Department of Haemostasis and Haemostatic Disorders, Lodz Medical University, Lodz, Poland
4 Cardiology Department, Medical University of Warsaw, Warsaw, Poland
5 Cardiology Department, Postgraduate Medical Center, Warsaw, Poland
6 Biochemical Department, Institute of Cardiology, Warsaw, Poland
7 Medical Academy, Gdansk, Poland
8 Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze, Poland
9 3rd Department of Medicine, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria
10 Department of Cardiology, Ullevål University Hospital, Oslo, Norway
11 Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
12 Institute of Cardiology and Center of Excellence on Aging, ‘G. d'Annunzio’ University—Chieti and CNR Institute of Clinical Physiology, Chieti C/o Ospedale SS. Annunziata Via dei Vestini, 66013 Chieti, Italy
Received 29 June 2008; revised 19 November 2008; accepted 27 November 2008.
* Corresponding author. Tel: +39 0871 415 12, Fax: +39 0871 402 817/492 817, Email: rdecater{at}unich.it
Oral antiplatelet drugs are a cornerstone of modern pharmacotherapy in cardiovascular atherothrombotic diseases. The efficacy of acetylsalicylic acid (ASA, aspirin) and clopidogrel in decreasing the risk of adverse events in coronary heart disease patients has been well established in the past 20 years. Despite chronic oral antiplatelet therapy, a number of atherothombotic events continue to occur. In recent years, a number of reports in the literature have shown possible relationships between residual platelet activity, as measured with a variety of laboratory tests, and clinical outcome, raising the possibility that ‘resistance’ to oral antiplatelet drugs may underlie many such clinical adverse events. The present position paper, conveyed within a group of clinical cardiologists with expertise in thrombosis appointed by the Section of Cardiovascular Interventions of the Polish Cardiac Society, has been further elaborated and endorsed by the Working Group on Thrombosis of the European Society of Cardiology. It aims at summarizing the main findings in this complex area, issuing opinions in cases of high controversy, and fostering future research in this area to obtain reliable laboratory and clinical data for the resolution of the many problems still open.
Key Words: Platelets • Antiplatelet agents • Monitoring • Resistance • Variability • Aspirin • Clopidogrel
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