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on September 23, 2004

Arteriosclerosis, Thrombosis, and Vascular Biology. 2004
Published online before print September 23, 2004, doi: 10.1161/01.ATV.0000145980.39477.a9
A more recent version of this article appeared on November 1, 2004
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Submitted on July 31, 2004
Accepted on September 10, 2004

Aspirin and Clopidogrel. Efficacy, Safety, and the Issue of Drug Resistance

Marco Cattaneo *

From Unità di Ematologia e Trombosi, Ospedale San Paolo, Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Milano.

* To whom correspondence should be addressed. E-mail: marco.cattaneo{at}unimi.it.

Abstract--Aspirin and the thienopyridines ticlopidine and clopidogrel are antiplatelet agents that display good antithrombotic activity. In the past few years, the concept of aspirin resistance has been largely emphasized in the medical literature, although its definition is still uncertain. I suggest that "aspirin-resistant" should be considered as a description for those individuals in whom aspirin fails to inhibit thromboxane A2 production, irrespective of the results of unspecific tests of platelet function, such as the bleeding time, platelet aggregation, or the PFA-100® system. Less well known than aspirin resistance, but certainly better characterized, is the issue of "clopidogrel resistance," which is probably mostly caused by inefficient metabolism of the prodrug clopidogrel to its active metabolite. At present, aspirin and clopidogrel resistance should not be looked for in the clinical setting, because there is no definite demonstration of an association with clinical events conditioning cost-effective changes in patient management.
Key words: aspirin resistance • clopidogrel resistance • antiplatelet agents • cardiovascular diseases • cerebrovascular diseases




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