| | Although the benefits of aspirin therapy for patients with arterial vascular disease are well established, [1-3] new insights regarding aspirin continue to emerge. Among the most interesting new areas of research is aspirin resistance. In this expert commentary, Deepak L. Bhatt, MD, Director of the Interventional Cardiovascular Fellowship at the Cleveland Clinic Foundation in Cleveland, Ohio, discusses the current data available on aspirin resistance and how these data should influence clinical decision-making.
The study of aspirin resistance is in its infancy. In this timely commentary, the evidence for aspirin resistance, the possible mechanisms of aspirin resistance, and the current methods available for the measurement of aspirin resistance are discussed. Dr Bhatt also addresses the key question: in patients in whom aspirin resistance has been identified, what exactly should physicians do to reduce the risk to the patient?
Dr Bhatt’s authoritative and thorough commentary also addresses the future of antiplatelet therapy. He discusses the potential effect genomics will have on the dosing and delivery of aspirin and other antiplatelet drugs, and he reviews recent trials of newer drugs, such as prasugrel and clopidogrel.
References
1. Antiplatelet Trialists’ Collaboration. Collaborative overview of randomized trials of antiplatelet therapy, I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1994;308:81-106.
2. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). 2004. Available at: www.acc.org/clinical/guidelines/stemi/index.pdf.
3. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). 2002. Available at: http://www.acc.org/clinical/guidelines/unstable/unstable.pdf.
Suggested Reading List
1. Ambrus JL, Ambrus CM, Akhter S. Aspirin "allergy" and resistance. J Am Coll Cardiol. 2004;44:939-940.
2. Bhatt DL. Aspirin resistance: more than just a laboratory curiosity. J Am Coll Cardiol. 2004;43:1127-1129.
3. Chen WH, Lee PY, Ng W, et al. Aspirin resistance is associated with a high incidence of myonecrosis after non-urgent percutaneous coronary intervention despite clopidogrel pretreatment. J Am Coll Cardiol. 2004;43:1122-1126.
4. Eikelboom JW, Hankey GJ. Aspirin resistance: a new independent predictor of vascular events? J Am Coll Cardiol. 2003;41:966-968.
5. Gum PA, Kottke-Marchant K, Welsh PA et al. A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol. 2003;41:961-965.
6. Jilma B. Therapeutic failure or resistance to aspirin. J Am Coll Cardiol. 2004;43:1332; author reply 1332-1333.
7. Lepantalo A, Virtanen KS, Heikkila J, et al. Limited early antiplatelet effect of 300 mg clopidogrel in patients with aspirin therapy undergoing percutaneous coronary interventions. Eur Heart J. 2004;25:476-483.
8. Macchi L, Christiaens L, Brabant S, et al. Resistance in vitro to low-dose aspirin is associated with platelet PlA1 (GP IIIa) polymorphism but not with C807T(GP Ia/IIa) and C-5T Kozak (GP Ibalpha) polymorphisms. J Am Coll Cardiol. 2003;42:1115-1119.
9. Orford JL, Fasseas P, Melby S, et al. Safety and efficacy of aspirin, clopidogrel, and warfarin after coronary stent placement in patients with an indication for anticoagulation. Am Heart J. 2004;147:463-467.
10. Steinhubl SR, Varanasi JS, Goldberg L, et al. Determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol. 2003;42:1336; author reply 1336-1337.
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