Abstract
Cardiovascular diseases are the most common cause of mortality and morbidity accounting for more than 40% of total mortality in Western countries, most of which is due to acute coronary syndromes (ACS), including ST and non- ST elevation myocardial infarction. An optimal pharmacological approach in these patients is of major importance with a particular emphasis on the antiplatelet regimen, which remains the cornerstone of the initial ACS treatment at hospital admission and during percutaneous coronary interventions (PCI). This review briefly discusses the pathogenesis of ACS, and updates the available pharmacological antithrombotic strategies with a particular focus on aspirin and clopidogrel resistance, which has caused major concern, especially in the modern era of interventional cardiology. Persistent platelet reactivity despite aspirin or clopidogrel intake is probably a risk factor for the recurrence of ischemic events. Despite a lack of uniformly accepted definitions of aspirin and clopidogrel resistance, we provide an objective description of what is already proved and what remains to be established. In clopidogrel poor-responders, preliminary data suggest that increasing the loading dose might be beneficial prior to PCI, while trials on the potential benefit of an increased maintenance dose after PCI are ongoing. Overall, data on the mechanisms and the management of platelet hyperactivity or antiplatelet drug biological resistance are still scarce and further studies are needed.
Keywords: Acute coronary syndromes, aspirin, clopidogrel, resistance
Current Vascular Pharmacology
Title: Acute Coronary Syndrome and its Antithrombotic Treatment: Focus on Aspirin and Clopidogrel Resistance
Volume: 7 Issue: 2
Author(s): Robert F. Bonvini, Jean-Luc Reny, Francois Mach, Thomas Zeller and Pierre Fontana
Affiliation:
Keywords: Acute coronary syndromes, aspirin, clopidogrel, resistance
Abstract: Cardiovascular diseases are the most common cause of mortality and morbidity accounting for more than 40% of total mortality in Western countries, most of which is due to acute coronary syndromes (ACS), including ST and non- ST elevation myocardial infarction. An optimal pharmacological approach in these patients is of major importance with a particular emphasis on the antiplatelet regimen, which remains the cornerstone of the initial ACS treatment at hospital admission and during percutaneous coronary interventions (PCI). This review briefly discusses the pathogenesis of ACS, and updates the available pharmacological antithrombotic strategies with a particular focus on aspirin and clopidogrel resistance, which has caused major concern, especially in the modern era of interventional cardiology. Persistent platelet reactivity despite aspirin or clopidogrel intake is probably a risk factor for the recurrence of ischemic events. Despite a lack of uniformly accepted definitions of aspirin and clopidogrel resistance, we provide an objective description of what is already proved and what remains to be established. In clopidogrel poor-responders, preliminary data suggest that increasing the loading dose might be beneficial prior to PCI, while trials on the potential benefit of an increased maintenance dose after PCI are ongoing. Overall, data on the mechanisms and the management of platelet hyperactivity or antiplatelet drug biological resistance are still scarce and further studies are needed.
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Cite this article as:
Bonvini F. Robert, Reny Jean-Luc, Mach Francois, Zeller Thomas and Fontana Pierre, Acute Coronary Syndrome and its Antithrombotic Treatment: Focus on Aspirin and Clopidogrel Resistance, Current Vascular Pharmacology 2009; 7 (2) . https://dx.doi.org/10.2174/157016109787455662
DOI https://dx.doi.org/10.2174/157016109787455662 |
Print ISSN 1570-1611 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6212 |
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Cardiovascular disease still remains the leading cause of death in Chronic and End Stage Kidney Disease, accounting for more than half of all deaths in dialysis patients. During the past decade, research has been focused on novel therapeutic agents that might delay or even reverse cardiovascular disease and vascular calcification, ...read more
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