Comparison of Three Tests to Distinguish Platelet Reactivity in Patients with Renal Impairment during Dual Antiplatelet Therapy

Lipids play an essential role in platelet functions. It is known that polyunsaturated fatty acids play a role in increasing platelet reactivity and that the prothrombotic phenotype plays a crucial role in the occurrence of major adverse cardiovascular events. The ongoing increase in cardiovascular diseases’ incidence emphasizes the importance of research linking lipids and platelet function. In particular, the rebound phenomenon that accompanies discontinuation of clopidogrel in patients receiving dual antiplatelet therapy has been associated with changes in the lipid profile. Our many years of research underline the importance of reduced HDL values for the risk of such a rebound effect and the occurrence of thromboembolic events. Lipids are otherwise a heterogeneous group of molecules, and their signaling molecules are not deposited but formed “on-demand” in the cell. On the other hand, exosomes transmit lipid signals between cells, and the profile of such changes can be monitored by lipidomics. Changes in the lipid profile are organ-specific and may indicate new drug action targets.

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Sex differences in the effect of diabetes mellitus on platelet reactivity and coronary thrombosis: From the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents (ADAPT-DES) study

International Journal of Cardiology ◽

10.1016/j.ijcard.2017.05.091 ◽

2017 ◽

Vol 246 ◽

pp. 20-25 ◽

Cited By ~ 8

Author(s):

Gennaro Giustino ◽

Björn Redfors ◽

Roxana Mehran ◽

Ajay J. Kirtane ◽

Usman Baber ◽

...

Keyword(s):

Diabetes Mellitus ◽

Sex Differences ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Platelet Reactivity ◽

Coronary Thrombosis ◽

Drug Eluting Stents ◽

Drug Eluting

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Clopidogrel Resistance: Current Issues

Journal of Enam Medical College ◽

10.3329/jemc.v6i1.26381 ◽

2016 ◽

Vol 6 (1) ◽

pp. 38-46

Author(s):

NS Neki

Keyword(s):

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Ex Vivo ◽

Platelet Reactivity ◽

Antiplatelet Agents ◽

Clinical Problem ◽

Coronary Intervention ◽

Platelet Activity ◽

Clopidogrel Resistance ◽

Underlying Mechanisms

Antiplatelet agents are mainly used in the prevention and management of atherothrombotic complications. Dual antiplatelet therapy, combining aspirin and clopidogrel, is the standard care for patients having acute coronary syndromes or undergoing percutaneous coronary intervention according to the current ACC/AHA and ESC guidelines. But in spite of administration of dual antiplatelet therapy, some patients develop recurrent cardiovascular ischemic events especially stent thrombosis which is a serious clinical problem. Antiplatelet response to clopidogrel varies widely among patients based on ex vivo platelet function measurements. Clopidogrel is an effective inhibitor of platelet activation and aggregation due to its selective and irreversible blockade of the P2Y12 receptor. Patients who display little attenuation of platelet reactivity with clopidogrel therapy are labeled as low or nonresponders or clopidogrel resistant. The mechanism of clopidogrel resistance remains incompletely defined but there are certain clinical, cellular and genetic factors including polymorphisms responsible for therapeutic failure. Currently there is no standardized or widely accepted definition of clopidogrel resistance. The future may soon be realised in the routine measurement of platelet activity in the same way that blood pressure, cholesterol and blood sugar are followed to help guide the therapy, thus improving the care for millions of people. This review focuses on the methods used to identify patients with clopidogrel resistance, the underlying mechanisms, metabolism, clinical significance and current therapeutic strategies to overcome clopidogrel resistance.J Enam Med Col 2016; 6(1): 38-46

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