Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24:1980-1987
Published online before print September 23, 2004, doi: 10.1161/01.ATV.0000145980.39477.a9
Published online before print September 23, 2004, doi: 10.1161/01.ATV.0000145980.39477.a9
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© 2004 American Heart Association, Inc.
Special Article |
Aspirin and Clopidogrel
Efficacy, Safety, and the Issue of Drug Resistance
From Unità di Ematologia e Trombosi, Ospedale San Paolo, Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Milano.
Correspondence to Marco Cattaneo, Unità di Ematologia e Trombosi, Ospedale San Paolo, Università di Milano, Via di Rudinì, 8, 20142 Milano, Italy. E-mail marco.cattaneo{at}unimi.it
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.
Aspirin and clopidogrel display good antithrombotic activity. For investigational purposes, aspirin and clopidogrel resistance should be evaluated in compliant patients by studying the effect of each drug on its specific target. They should not be looked for in the clinical setting yet, because definite demonstration of association with clinical events is lacking.
Key Words: aspirin resistance • clopidogrel resistance • antiplatelet agents • cardiovascular diseases • cerebrovascular diseases
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