Antiplatelet Resistance in Acute Coronary Syndrome Patients: Mechanisms, Clinical Implications, and Management Strategies

doi:N/A

Bangaldesh Journal of Cardivascular Medicine

2024, Volume 2, Issue 3 : 1-7

Research Article

Antiplatelet Resistance in Acute Coronary Syndrome Patients: Mechanisms, Clinical Implications, and Management Strategies

Farhan A. Siddiqui

Sophia L. Bennett

Michael J. Carter

Emily R. Thompson

⁴

Department of Cardiology, Global Heart Institute, London, United Kingdom

Division of Interventional Cardiology, European Cardiovascular Research Center, Berlin, Germany

Department of Internal Medicine and Cardiovascular Sciences, International Medical University, Singapore

⁴

Center for Thrombosis and Cardiovascular Outcomes Research, New York, USA

Abstract

Antiplatelet therapy is central to the management of Acute Coronary Syndrome (ACS), particularly in patients undergoing percutaneous coronary intervention. However, a proportion of patients demonstrate inadequate pharmacodynamic response to antiplatelet agents, commonly referred to as antiplatelet resistance or high on-treatment platelet reactivity. This phenomenon is associated with recurrent ischemic events, stent thrombosis, myocardial infarction, and adverse cardiovascular outcomes. Resistance may occur with aspirin, clopidogrel, and, less frequently, newer P2Y12 inhibitors. Multiple mechanisms contribute to antiplatelet resistance, including genetic polymorphisms, poor drug absorption, drug interactions, diabetes mellitus, chronic kidney disease, obesity, inflammation, and non-adherence. This review examines the pathophysiology, diagnostic methods, clinical impact, and management strategies for antiplatelet resistance in ACS patients. An Integrated Antiplatelet Response Optimization Framework is proposed to support individualized antithrombotic therapy and improve clinical outcomes.

Keywords

Antiplatelet Resistance

Acute Coronary Syndrome

Aspirin Resistance

Clopidogrel Resistance

Platelet Reactivity

P2Y12 Inhibitors

Stent Thrombosis

Personalized Medicine

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