Abstract
Oral antiplatelet therapy is a key element of the continuously evolving treatment
of acute coronary syndromes. As part of this evolution, resistance to oral antiplatelet
therapy has emerged as a new challenge adversely affecting patients' clinical risk
and outcome. This review addresses the role of two oral antiplatelet therapy agents,
aspirin and clopidogrel, their mechanism of action, and the evidence supporting their
use in the setting of coronary artery disease. Unfortunately, clinically relevant
resistance to aspirin and clopidogrel exists. Resistance may indicate a higher risk
for major adverse events. An established safe and reliable treatment alternative is
lacking at this point; further research is needed to evaluate the efficacy of any
alternative treatments that can be offered to decrease cardiovascular risk and improve
clinical outcomes.
Abbreviations
ADP =: adenosine diphosphate;
CAPRIE =: Clopidogrel vs. Aspirin in Patients at Risk of Ischaemic Events;
CHARISMA =: Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization,
Management, and Avoidance;
COX =: cyclooxygenase;
CREDO =: Clopidogrel for the Reduction of Events During Observation;
CURE =: the Clopidogrel in Unstable angina to prevent Recurrent Events;
GP =: glycoprotein;
LDL =: low-density lipoprotein;
NO =: nitrous oxide;
ISIS-2 =: Second International Study of Infarct Survival;
PG =: prostaglandin;
PGI2 =: prostacyclin;
TX =: thromboxane;
TXA2 =: thromboxane A2.
