Resistenz gegen Azetylsalizylsäure und Clopidogrel

Zusammenfassung

Resistenz gegen Azetylsalizylsäure (ASS) bzw. Clopidogrel wird vom klinischen Gesichtspunkt als Unvermögen des Wirkstoffs angesehen, rezidivierende arterielle Gefäßverschlüsse zu verhindern. Aus laborchemischer Sicht hingegen wird die Non-Response gegenüber ASS und Clopidogrel als das Ausbleiben eines erwarteten Effektes in verschiedenen Thrombozytenfunktionstestsystemen beschrieben. Etablierte Thrombozytenfunktionsteste ermöglichen meist keine spezifischen Aussagen über die Thrombozytenaggregationshemmung durch ASS oder Clopidogrel. Wünschenswert wäre, die ASS- und Clopidogrel-Non-Response mit Plättchenfunktionstesten derart zu ermitteln, dass isoliert die spezifischen Effekte dieser Arzneimittel erfasst werden. Im Idealfall könnte eine solche Labordiagnostik helfen, klinische Ereignisse aufgrund eines Therapieversagens im Vorfeld zu verhindern. Studien, die eine Prävalenz von 5 bis 59% für die ASS- oder Clopidogrel-Non-Response angeben, geben erste Hinweise dafür, dass der Nachweis einer laborchemischen ASS- oder Clopidogrel-Non-Response mit dem nachfolgendem Auftreten vaskulärer Reereignisse assoziiert sein könnte. Allerdings sind diese Studien durch zu geringe Fallzahlen, fehlende Standardisierung der Labormethoden und sehr differente Einschlusskriterien in ihrer Aussagekraft limitiert. Deshalb bleibt die klinische Relevanz laborchemisch nachgewiesener ASS- oder Clopidogrel- Resistenz unklar und sollte umgehend in prospektiven Multizenterstudien geklärt werden. Die individuellen Ursachen einer reduzierten oder ausbleibenden Wirkung von ASS oder Clopidogrel können multifaktoriell sein. Die Mechanismen der ASS- bzw. Clopidogrel- Resistenz sind weitgehend ungeklärt.

Summary

Resistance to acetylsalicylic acid (ASA) or clopidogrel is understood from the clinical point of view as failure of the drugs to prevent recurrent vascular occlusions. Non-response to ASA and clopidogrel is defined from the laboratory aspect as an inability to cause in vitro detectable platelet function inhibition. It would be beneficial to monitor non-response to ASA or clopidogrel with platelet function methods, which detect the specific effect of these drugs, and thus prevent clinical events caused by failure of therapy. Non-response to ASA and clopidogrel are detected with different platelet function methods, which are not always clinically standardized and are assessing only the global platelet function and not the specific drug effect. Although various studies reporting 5 to 59% non-response for both drugs, support a clinical relevance of ASA and clopidogrel non-response, well-designed clinical prospective trials are required to identify patients with antiplatelet drug resistance. Furthermore, mechanisms explaining this phenomenon of drug resistance are still unknown.

Schlüsselwörter

Azetylsalizylsäure-Resistenz - Clopidogrel-Resistenz - Thromboyztenfunktionsteste

Keywords

ASA resistance - clopidogrel resistance - platelet function tests

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