title: Mechanisms of variability in antiplatelet agents response.
abstract: Inter-individual variability in the response to antiplatelet drugs has been reported. Suboptimal response to aspirin, as determined by specific tests, is rare and, in most instances, caused by poor compliance. In contrast, it is well established that the pharmacological response to clopidogrel is widely variable, with a significant proportion of subjects (about 1/3) being very poor responders. Inter-individual difference in the extent of metabolism of clopidogrel to its active metabolite is the most plausible mechanism for the observed inter-individual variability in platelet inhibition. Tailored treatment based on laboratory monitoring of platelet function has been proposed as a solution to poor responsiveness to clopidogrel. However, we still need to identify the ideal laboratory test and to answer basic questions on its clinical utility and cost-effectiveness, before monitoring clopidogrel therapy can be recommended in clinical practice.
authors.affiliation: Unità di Medicina 3, Ospedale San Paolo, Dipartimento di Medicina, Chirurgia e Odontoiatria, Università degli Studi di Milano, Milano, Italy. marco.cattaneo@unimi.it
authors.forename: Marco
authors.initials: M
authors.lastname: Cattaneo
mesh_terms: D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D001711:Biotransformation / Q000235:genetics; D000077144:Clopidogrel; D016903:Drug Monitoring / Q000379:methods; D004351:Drug Resistance; D005838:Genotype; D006801:Humans; D018579:Patient Selection; D010597:Pharmacogenetics; D010641:Phenotype; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D010979:Platelet Function Tests; D057285:Precision Medicine; D011237:Predictive Value of Tests; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin