Anti-platelet drug resistance

Anti-platelet drug resistance

Studies at home and abroad have shown that some patients often have varying degrees of resistance to antiplatelet drugs. In light of the possible mechanisms, Professor Gong Yanjun, the First Affiliated Hospital of Peking University, summarized several measures for responding to antiplatelet drug resistance.

Genetic screening studies have shown that cytochrome (CYP) 2C19 gene mutations are associated with clopidogrel resistance. For high-risk patients requiring enhanced platelet therapy, it is advisable to screen for related genes to guide antiplatelet therapy.

Combination or replacement studies of antiplatelet agents have shown that the novel anticoagulant drug ticagrelor versus clopidogrel can significantly reduce the risk of a composite end point in patients with acute coronary syndrome (ACS) (P<0.001). However, in patients with aspirin resistance, clopidogrel plus clopidogrel did not benefit from any cardiovascular events, and the replacement of a new type of adenosine diphosphate (ADP) drug is effective, yet to be further confirmed by research.

In combination with proton pump inhibitor (PPI), improving patient compliance Adverse drug reactions are one of the major factors affecting patient compliance. Recent studies confirm that the combination of aspirin and PPI can reduce gastrointestinal bleeding, thereby improving patient compliance with aspirin use. For clopidogrel, based on the clinical net benefit, the 2013 United States Guidelines for Acute ST-elevation Myocardial Infarction suggest the use of clopidogrel in combination with PPI.

Increasing drug doses and times Duzenll et al.'s study showed that increasing the dose of aspirin can significantly increase platelet aggregation in patients with diabetes with cardiovascular disease. At the same time, several studies have confirmed that improving aspirin resistance in diabetic patients increases the number of dosing more than increasing the single dose, and this conclusion still needs further clinical research to further confirm.

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