Terapia antiplaquetaria/Antiplatelet therapy

El tratamiento antiplaquetario para prevenir el accidente cerebrovascular recurrente: tres buenas opciones


Antiplatelet therapy to prevent recurrent stroke: Three good options.
Mansoor AH, Mujtaba MT, Silver B.
Department of Cardiovascular Services, PinnacleHealth Cardiac and Vascular Institute, PinnacleHealth Hospitals, Harrisburg, PA.
Cleve Clin J Med. 2013 Dec;80(12):787-95. doi: 10.3949/ccjm.80a.12149.
Abstract
Drugs that prevent platelets from sticking together-ie, aspirin, dipyridamole, and clopidogrel-are an important part of therapy to prevent recurrence of ischemic stroke of atherosclerotic origin. We discuss current indications for these drugs and review the evidence behind our current use of aspirin, dipyridamole, and clopidogrel.
http://www.ccjm.org/content/80/12/787.full.pdf



Resistencia a los antiplaquetarios el accidente cerebrovascular.

Antiplatelet resistance in stroke.
Topçuoglu MA, Arsava EM, Ay H.
Hacettepe University Hospitals, Department of Neurology, Ankara, Turkey.
Expert Rev Neurother. 2011 Feb;11(2):251-63. doi: 10.1586/ern.10.203.
Abstract
Although the exact prevalence of antiplatelet resistance in ischemic stroke is not known, estimates about the two most widely used antiplatelet agents - aspirin and clopidogrel - suggest that the resistance rate is high, irrespective of the definition used and parameters measured. Inadequate antiplatelet responsiveness correlates with an increased risk of recurrent ischemic vascular events in patients with stroke and acute coronary syndrome. It is not currently known whether tailoring antiplatelet therapy based on platelet function test results translates into a more effective strategy to prevent secondary vascular events after stroke. Large-scale clinical trials using a universally accepted definition and standardized measurement techniques for antiplatelet resistance are needed to demonstrate whether a 'platelet-function test-guided antiplatelet treatment' strategy translates into improved stroke care. This article gives an overview of the clinical importance of laboratory antiplatelet resistance, describes the challenges for platelet-function test-guided antiplatelet treatment and discusses practical issues about the management of patients with aspirin and/or clopidogrel resistance.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086673/pdf/nihms284137.pdf



Alta reactividad plaquetaria residual sobre clopidogrel: su significado y retos terapéuticos para superar la resistencia a clopidogrel. 

High residual platelet reactivity on clopidogrel: its significance and therapeutic challenges overcoming clopidogrel resistance.
Garabedian T, Alam S.
Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon.
Cardiovasc Diagn Ther. 2013 Mar;3(1):23-37.
Abstract
Over the last decade, dual antiplatelet therapy has been the mainstay of the management of Acute Coronary Syndrome, with clopidogrel therapy providing clear benefits over aspirin monotherapy and becoming the agent of choice for the prevention of stent thrombosis. While newer antiplateletagents have now become available, clopidogrel is still widely used due to its low cost and efficacy. However, many patients still experience recurrent ischemic events. A poor response of the platelets to clopidogrel, called High Residual Platelet Reactivity (HRPR), has been incriminated to account for this dilemma. Despite the absence of a universal definition of HRPR or the gold standard test to quantify it, persistent high platelet reactivity has consistently been associated with recurrence of ischemic events. Clopidogrel metabolism is highly variable, and genetics, comorbidities and drug interactions can affect it. In this article we review all definitions of HRPR, explore the available tests to quantify it, the clinical outcomes associated with it, as well as strategies that have shown success in overcoming it.
KEYWORDS: Acute coronary syndrome, clopidogrel, platelet aggregation, platelet reactivity

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839215/pdf/cdt-03-01-023.pdf



Atentamente
Dr. Juan C. Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org