Clopidogrel resistance: current aspects and future directions.

Abstract

D ual antiplatelet therapy combi­ ning aspirin and clopidogrel is the standard care for patients who have acute coronary syndromes (ACS) or are undergoing percutaneous coronary in­ tervention (PCI), according to the current ACC/AHA and ESC guidelines. How­ ever, despite the administration of dual antiplatelet therapy, some patients do de­ velop recurrent cardiovascular ischemic events, with stent thrombosis being the most catastrophic. It is well established that the antiplatelet response to clopido­ grel varies widely among patients. Pa­ tients who display little attenuation of platelet reactivity under clopidogrel thera­ py are recognized as low­ or non­respond­ ers, or clopidogrel­resistant. This review focuses on the methods used to identify patients with low clopidogrel responsive­ ness, the underlying mechanisms, clinical significance and current therapeutic strat­ egies to overcome clopidogrel resistance.