title: Obesity and Antiplatelets-Does One Size Fit All?
abstract: Antiplatelet therapy has become a cornerstone in the management of many vascular diseases. With growing antiplatelet options, attention has focused on their comparative effectiveness in specific patient populations. Perhaps one of the least defined factors influencing efficacy of these agents is body mass and obesity. Evidence from preclinical models established that obesity promotes inflammation that in turn enhances platelet reactivity. Thus, adiposity has the potential to diminish or alter the therapeutic effect of antiplatelet therapy. Pharmacodynamic analyses suggest a potential need for dose adjustments of antiplatelet therapy in obese patients. Yet, obese patients paradoxically have better outcomes after acute coronary syndromes. In this review, we identify a critical need for clinical studies with outcome data to enable the development of recommendations for optimal antiplatelet regimens in obese individuals. Until such data exists, healthcare providers should be aware of the potential impact of obesity on the efficacy of anti-platelet therapy.
authors.affiliation: TriStar Centennial Medical Center, Nashville, TN, USA; University of Tennessee College of Pharmacy, USA. Electronic address: craig.beaverspharmd@gmail.com.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Beavers
authors.affiliation: Gill Heart Institute, University of Kentucky HealthCare, Lexington, KY, USA. Electronic address: pmhero2@uky.edu.
authors.forename: Paula
authors.initials: P
authors.lastname: Heron
authors.affiliation: Gill Heart Institute, University of Kentucky HealthCare, Lexington, KY, USA. Electronic address: susan.smyth@uky.edu.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Smyth
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, CA, USA. Electronic address: jonabain@gmail.com.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Bain
authors.affiliation: Gill Heart Institute, University of Kentucky HealthCare, Lexington, KY, USA. Electronic address: temaca2@uky.edu.
authors.forename: Tracy E
authors.initials: TE
authors.lastname: Macaulay
mesh_terms: D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D006801:Humans; D009765:Obesity / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Antiplatelets; Clopidogrel; Obesity; Platelets; Reactivity