Common use of Antiplatelet therapy Clause in Contracts

Antiplatelet therapy. The use of antiplatelet agents, both oral and parenteral, in the treatment of CHD was intro- duced based on the solid evidence for the major role of platelets both in the early stages of atherosclerosis as well as in thrombus formation during rupture of the vulnerable plaque. Despite the progress achieved, it is generally accepted that our strategies are far from be- ing considered optimal. The need for new oral antiplatelet agents is mainly driven by two reasons: the increased bleeding risk, particularly in those patients in need for double or triple antiplatelet therapy, and the variable response or “resistance” of patients to treatment clini- cally expressed as thrombotic complications or “treatment failure”. The increased bleeding risk is strongly associated with the irreversible nature of current agents’ platelet inhibition and represents a major issue in the setting of urgent cardiac or non-cardiac surgery. This has led to a lot of discussion regarding the appropriate selection of cases suitable for gly- coprotein (GP) IIb/IIIa inhibitors administration, timing of their administration (in respect to patients’ catheterization) and duration of treatment. On the other hand, “resistance” to antiplatelet treatment is both difficult to be assessed and multi-factorial in its nature involv- ing (commonly neglected) parameters such as poor compliance and inadequate absorption but also drug interactions and pharmacogenetic factors. Moreover, it has been shown that lower response to aspirin and clopidogrel is frequent among acute coronary syndrome (ACS) patients as well as in those with hypertension, diabetes type 2, smoking, obesity (particularly in females), heart failure and hypercholesterolemia with the involved pathophysiological mechanisms to a significant extent unclear32.