Abstract
Antiplatelet therapy is used to reduce the risk of ischemic events in patients with cardiovascular disease. The balance of benefits and risks of antiplatelet drugs in coronary artery disease has been evaluated in large-scale randomised trials, however the absolute benefit for an individual patient and a specific platelet-active drug need further evaluation. Several well-conducted studies have demonstrated a substantial inter-individual variability in the platelet responsiveness to drugs. The historical “gold standard” test of platelet function (optical aggregation) has well established limitations for measuring the effect of antiplatelet drugs. Other new tests developed (i.e. PFA-100®, VerifyNow®) may overcome some of these limitations but they do not correlate well with each other. Despite these unresolved methodological questions, several recent clinical studies, but not all, suggest a significant correlation between antiplatelet resistance status and serious vascular events. In these conditions, laboratory monitoring for antiplatelet therapies raises several questions: (i) the necessity for a consensus on the definition of resistance and on the best test for evaluation of the condition, (ii) the demonstration that biological resistance has clinical significance, and (iii) the clinical impact of adapting the antiplatelet therapy. Therefore, it is not currently appropriate to test patients or to change therapy on the basis of such tests, other than in prospective and adequately powered clinical trials.
Keywords: Aspirin, clopidogrel, coronary artery disease, platelet aggregation inhibitors, platelet function
Current Vascular Pharmacology
Title: Monitoring of the Antiplatelet Drugs Effect in Patients with Coronary Artery Disease: What is the Real Clinical Impact?
Volume: 5 Issue: 4
Author(s): Luc Christiaens and Laurent Macchi
Affiliation:
Keywords: Aspirin, clopidogrel, coronary artery disease, platelet aggregation inhibitors, platelet function
Abstract: Antiplatelet therapy is used to reduce the risk of ischemic events in patients with cardiovascular disease. The balance of benefits and risks of antiplatelet drugs in coronary artery disease has been evaluated in large-scale randomised trials, however the absolute benefit for an individual patient and a specific platelet-active drug need further evaluation. Several well-conducted studies have demonstrated a substantial inter-individual variability in the platelet responsiveness to drugs. The historical “gold standard” test of platelet function (optical aggregation) has well established limitations for measuring the effect of antiplatelet drugs. Other new tests developed (i.e. PFA-100®, VerifyNow®) may overcome some of these limitations but they do not correlate well with each other. Despite these unresolved methodological questions, several recent clinical studies, but not all, suggest a significant correlation between antiplatelet resistance status and serious vascular events. In these conditions, laboratory monitoring for antiplatelet therapies raises several questions: (i) the necessity for a consensus on the definition of resistance and on the best test for evaluation of the condition, (ii) the demonstration that biological resistance has clinical significance, and (iii) the clinical impact of adapting the antiplatelet therapy. Therefore, it is not currently appropriate to test patients or to change therapy on the basis of such tests, other than in prospective and adequately powered clinical trials.
Export Options
About this article
Cite this article as:
Christiaens Luc and Macchi Laurent, Monitoring of the Antiplatelet Drugs Effect in Patients with Coronary Artery Disease: What is the Real Clinical Impact?, Current Vascular Pharmacology 2007; 5 (4) . https://dx.doi.org/10.2174/157016107782023361
DOI https://dx.doi.org/10.2174/157016107782023361 |
Print ISSN 1570-1611 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6212 |
Call for Papers in Thematic Issues
Ischemic Cardiovascular Diseases: Mechanisms, Diagnosis and Therapy
Ischemic cardiovascular disease includes myocardial infarction, coronary atherosclerotic heart disease, angina pectoris, etc., constitute the leading cause of patient mortality by preventing tissues from getting sufficient oxygen and nutrients. Ischemic heart disease, as a clinical condition, is characterized by myocardial ischemia, causing an imbalance between myocardial blood supply and demand, ...read more
TREATMENT OF CARDIOVASCULAR DISEASE IN CHRONIC AND END STAGE KIDNEY DISEASE
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
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Role of Dietary Xenobiotics-Gene Interactions in Carcinogenesis: Protective Effects of Nutritional Factors
Current Nutrition & Food Science In Vivo Roles of CDC25 Phosphatases: Biological Insight into the Anti-Cancer Therapeutic Targets
Anti-Cancer Agents in Medicinal Chemistry MicroRNAs and Cardiac Conduction
Current Drug Targets Clinical Utility of Neoadjuvant Endocrine Therapy for Hormone Receptor Positive Breast Cancer
Reviews on Recent Clinical Trials Berberine as a Promising Safe Anti-Cancer Agent- Is there a Role for Mitochondria?
Current Drug Targets Gender Differences in Ischemic Heart Disease
Recent Patents on Cardiovascular Drug Discovery The Pleiotropic Effects of ARB in Vascular Endothelial Progenitor Cells
Current Vascular Pharmacology Blockade of Insulin-Like Growth Factor Type-1 Receptor with Cixutumumab (IMC-A12): A Novel Approach to Treatment for Multiple Cancers
Current Drug Targets Melatonin and Hypothalamic-Pituitary-Gonadal Axis
Current Medicinal Chemistry Management of Hypertension-Journey from Single Drug Therapy to Multitargeted Ligand Therapy: A Clinical Overview
Current Clinical Pharmacology Evaluation of In Vivo Efficacy of Aqueous Extract of Aerial Parts of Cynodon dactylon in Rats with Simultaneous Type 2 Diabetes and Hypertension
Current Bioactive Compounds Therapeutic Implications of Tocilizumab, A Humanized Anti-Interleukin-6 Receptor Antibody, for Various Immune-Mediated Diseases: An Update Review
Current Rheumatology Reviews Cysteine Proteinases of Trypanosome Parasites Novel Targets for Chemotherapy
Current Drug Targets The Biochemical Mechanisms of T-Cell Anergy
Current Immunology Reviews (Discontinued) Chaperones and Cardiac Misfolding Protein Diseases
Current Protein & Peptide Science Platelet Function in Inflammatory Diseases: Insights from Clinical Studies
Inflammation & Allergy - Drug Targets (Discontinued) Dietary Phytochemicals in Chemoprevention of Cancer: An Update
Immunology, Endocrine & Metabolic Agents in Medicinal Chemistry (Discontinued) Endothelial Dysfunction in Cardiac Allograft Vasculopathy: Potential Pharmacological Interventions
Current Vascular Pharmacology Efficacy of Topical Formulations in Healing of Caesarean Scars Using Non-Invasive Devices: A Controlled Trial
Applied Drug Research, Clinical Trials and Regulatory Affairs Tetrahydrobiopterin: A Vascular Redox Target to Improve Endothelial Function
Current Vascular Pharmacology