Factors influencing the effectiveness of antiplatelet therapy

Abstract

In recent years, significant advances in the diagnosis and treatment of cardiovascular diseases have been achieved in the healthcare of most countries. However, among the causes of mortality in patients with coronary heart disease, arterial thrombosis takes one of the leading positions. Antiplatelet drugs are prescribed to prevent thrombotic complications, which can be used as mono- or two-component therapy. In case of atherosclerosis in arteries, acetyl-salicylic acid (ASA) or clopidogrel can be used as monotherapy; treatment of acute coronary syndrome (ACS) and percutaneous coronary interventions (PCI) required using of double antiplatelet therapy (DAT), including acetylsalicylic acid drugs together with one antiplatelet agent from the group of thienopyridine derivatives — blockers of P2Y12 platelet receptors (clopidogrel, ticagrelor, prasugrel). In patients with ACS who underwent primary PCI or thrombolysis followed by PCI, the duration of DAT is 12 months, and clopidogrel is the drug of choice [16, 30]. According to various literature sources about 20–40% of patients have low effectiveness of antiplatelet therapy, which can lead to thrombosis, stent thrombosis and thromboembolic complications. This review provides an analysis of modifiable and nonmodifiable factors contribution to the development of clinical and laboratory resistance of antiplatelet agents.