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Aspirin and Clopidogrel in Acute Coronary Syndromes
Therapeutic Insights From the CURE Study
Hani Jneid, MD;
Deepak L. Bhatt, MD;
Roberto Corti, MD;
Juan J. Badimon, PhD;
Valentin Fuster, MD, PhD;
Gary S. Francis, MD
Arch Intern Med. 2003;163:1145-1153.
Platelet adhesion, activation, and aggregation are central to thrombus formation, which follows atherosclerotic plaque disruption and causes acute coronary syndromes. Aspirin and clopidogrel exert their antiplatelet effects by inhibiting thromboxane A2 production and adenosine diphosphate–induced platelet aggregation pathways, respectively. Aspirin has proven benefits in primary and secondary prevention of coronary artery disease. Clopidogrel, an alternative antiplatelet agent used in patients with aspirin intolerance, is especially useful in combination with aspirin after coronary stent procedures. The CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) study demonstrates for the first time the benefit of adding clopidogrel to aspirin rather than using aspirin alone in patients having acute coronary syndromes without ST-segment elevation myocardial infarction. Patients who are resistant to aspirin (up to 10%) have higher rates of cardiovascular events and may derive special benefit from the combination therapy. Aspirin resistance can be assessed through platelet aggregometry testing, measurement of urinary thromboxane metabolites, and, possibly, genomic testing in the future.
From the Division of Cardiology, University of Louisville, Louisville, Ky (Dr Jneid); Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio (Drs Bhatt and Francis); and the Cardiovascular Biology Research Laboratory (Drs Corti and Badimon) and the Zena and Michael A. Wiener Cardiovascular Institute (Dr Fuster), Mount Sinai Medical Center, New York, NY. Dr Bhatt has received honoraria for educational presentations from Sanofi-Synthelabo and Bristol-Myers-Squibb.
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