The Role of Laboratory Monitoring in Antiplatelet Therapy
In the last decade, several studies reported a high inter-individual variability in the pharmacological response to antiplatelet drugs. Suboptimal response to aspirin, as determined by specific tests (serum thromboxane B2), is rare and, when present, it a
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Contents 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 How to Measure the Pharmacological Response to Antiplatelet Drugs . . . . . . . . . . . . . . . . . . 3 Inter-individual Variability of Response to Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 Laboratory Tests to Measure the Response to Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2 Causes of Altered Pharmacological Response to Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3 Clinical Consequences of Altered Pharmacological Response to Aspirin . . . . . . . . . 3.4 Laboratory Monitoring of Aspirin Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Inter-individual Variability of Response to Clopidogrel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 Laboratory Tests to Measure the Response to Inhibitors of P2Y12 . . . . . . . . . . . . . . . . . 4.2 Inter-individual Variability in the Pharmacological Response to Clopidogrel . . . . . 4.3 Clinical Consequences of the Inter-individual Variability of Response to Clopidogrel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4 Laboratory Monitoring of Clopidogrel Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.5 Alternative Approaches to the Problem of Response Variability to Clopidogrel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Abstract In the last decade, several studies reported a high inter-individual variability in the pharmacological response to antiplatelet drugs. Suboptimal response to aspirin, as determined by specific tests (serum thromboxane B2), is rare and, when present, it appears to be caused by poor compliance in most instances. In contrast, studies that used specific tests to measure the pharmacological effect of clopidogrel showed a wide variability of response, with about 1/3 of treated subjects who are very poor responders. Inter-individual difference in the extent of metabolism of clopidogrel to its active metabolite by cytochrome P450 M. Cattaneo (*) Unita` di Medicina 3 – Ospedale San Paolo, Dipartimento di Scienze della Salute, Universita` degli Studi di Milano, Via di Rudinı` 8, 20142 Milano, Italy e-mail: [email protected] P. Gresele et al. (eds.), Antiplatelet Agents, Handbook o
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