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Aspirin Mediated Platelet Reactivity Following Vascular Procedures: The Path of Least Resistance is to Ignore it

      Dehne et al. have examined aspirin resistance after vascular intervention in this issue of the European Journal of Vascular and Endovascular Surgery.
      • Dehne S.
      • Heck C.
      • Sander J.
      • Meisenbacher K.
      • Arens C.
      • Niklas C.
      • et al.
      Association of PeriOPerative Aspirin-ResisTance and CardioVascular Outcome (POPART CVO): a prospective non-interventional cohort study.
      Antiplatelet resistance comes in several forms. It can be genetic, such as a platelet surface receptor mutation, which decreases the ability of a drug to bind and subsequently inhibits platelet function.
      • Zlatanovic P.
      • Wong K.H.F.
      • Kakkos S.K.
      • Twine C.P.
      A systematic review and meta-analysis on the impact of high on-treatment platelet reactivity on clinical outcomes for patients taking ADP receptor inhibitors following lower limb arterial endovascular intervention.
      More commonly it can be due to changes in metabolism, such as those seen during the response to surgical trauma, as examined by Dehne et al.
      • Dehne S.
      • Heck C.
      • Sander J.
      • Meisenbacher K.
      • Arens C.
      • Niklas C.
      • et al.
      Association of PeriOPerative Aspirin-ResisTance and CardioVascular Outcome (POPART CVO): a prospective non-interventional cohort study.
      Patients will also have normal platelet function if they do not take their medication. This might be the major contributing factor to most laboratory detected “good” or normal platelet reactivity, despite antiplatelet therapy.
      • Schwartz K.A.
      • Schwartz D.E.
      • Ghosheh K.
      • Reeves M.J.
      • Barber K.
      • DeFranco A.
      Compliance as a critical consideration in patients who appear to be resistant to aspirin after healing of myocardial infarction.
      “High on treatment platelet reactivity” is often used to encompass genetic and metabolic resistance, as well as factors such as non-compliance, as they are difficult to tell apart in the real world. Because such a diverse group of conditions are considered together, it has been historicallydifficult to understand the clinical importance of antiplatelet resistance.
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      References

        • Dehne S.
        • Heck C.
        • Sander J.
        • Meisenbacher K.
        • Arens C.
        • Niklas C.
        • et al.
        Association of PeriOPerative Aspirin-ResisTance and CardioVascular Outcome (POPART CVO): a prospective non-interventional cohort study.
        Eur J Vasc Endovasc Surg. 2022; 64: 407-415
        • Zlatanovic P.
        • Wong K.H.F.
        • Kakkos S.K.
        • Twine C.P.
        A systematic review and meta-analysis on the impact of high on-treatment platelet reactivity on clinical outcomes for patients taking ADP receptor inhibitors following lower limb arterial endovascular intervention.
        Eur J Vasc Endovasc Surg. 2022; 63: 91-101
        • Schwartz K.A.
        • Schwartz D.E.
        • Ghosheh K.
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