Interindividual variability in the response to oral antiplatelet drugs: a position paper of the Working Group on antiplatelet drugs resistance appointed by the Section of Cardiovascular Interventions of the Polish Cardiac Society, endorsed by the Working Group on Thrombosis of the European Society of Cardiology

Abstract

Oral antiplatelet drugs are a cornerstone of modern pharmacotherapy in cardiovascular atherothrombotic diseases. The efficacy of acetylsalicylic acid (ASA, aspirin) and clopidogrel in decreasing the risk of adverse events in coronary heart disease patients has been well established in the past 20 years. Despite chronic oral antiplatelet therapy, a number of atherothombotic events continue to occur. In recent years, a number of reports in the literature have shown possible relationships between residual platelet activity, as measured with a variety of laboratory tests, and clinical outcome, raising the possibility that 'resistance' to oral antiplatelet drugs may underlie many such clinical adverse events. The present position paper, conveyed within a group of clinical cardiologists with expertise in thrombosis appointed by the Section of Cardiovascular Interventions of the Polish Cardiac Society, has been further elaborated and endorsed by the Working Group on Thrombosis of the European Society of Cardiology. It aims at summarizing the main findings in this complex area, issuing opinions in cases of high controversy, and fostering future research in this area to obtain reliable laboratory and clinical data for the resolution of the many problems still open.

Urinary 11‐Dehydro‐Thromboxane B 2 as a Predictor of Acute Myocardial Infarction Outcomes: Results of Leukotrienes and Thromboxane In Myocardial Infarction (LTIMI) Study

“…TXA 2 is rapidly inactivated to TXB 2 and further undergoes dehydrogenation to 11‐dehydro‐TXB 2 5, 6. The latter is a stable metabolite excreted in urine, and its measurement provides a reliable estimate of the total in vivo production of TXA 2 including the extraplatelet sources 7, 8. 11‐Dehydro‐TXB 2 has been found to be elevated in several atherothrombotic diseases and to correlate with major adverse clinical events 9, 10, 11, 12, 13, 14.…”

The Adherence to Recommended Therapy in Patients After Acute Coronary Syndrome, and Risk of Cardiovascular Complications Within a Year After Hospital Admission

“…По нашим данным, низкая приверженность лечению является одной из причин «неудачи терапии» ИБС, что согласуется с точкой зрения W. Kuliczkowski и соавт., что применение термина «клиническая резистентность к АСК» в отличие от «лабораторной резистентности к АСК» неоправданно для всех случаев возникновения тром-ботических осложнений у кардиологических пациен-тов без анализа приверженности рекомендуемой те-рапии [26].…”

Aspirin resistance in coronary heart disease: Current understandings and strategies

“…[1] In 2009, the Working Group on Thrombosis of the European Society of Cardiology released a position paper on interindividual variability in the response to oral antiplatelets, in which, aspirin resistance was categorized as clinical resistance and laboratory resistance. [2] The clinical resistance is associated with occurrence of cardiovascular events when the patient is receiving aspirin, whereas the laboratory resistance is manifest by insufficiently suppressed platelet activity shown by invitro assays despite current use of aspirin.…”