Resistencia a la aspirina: un problema latente de alto riesgo
Resumen
La aspirina es la piedra angular del tratamiento en pacientes con enfermedades cardiovasculares y cerebrovasculares; sin embargo, varios estudios sobre la respuesta in vitro de las plaquetas a la administración de aspirina mostraron que esta respuesta es variable, encontrando algunos pacientes con falta de respuesta o resistencia a la aspirina. La resistencia a la aspirina puede ser ”clínica” o "de laboratorio". La resistencia clínica a la aspirina se define como el fracaso para evitar la aparición de los episodios isquémicos aterotrombóticos en pacientes a los que se les administra. La resistencia de laboratorio a la aspirina se define como el fracaso de la aspirina para inhibir la producción de tromboxano A2 por las plaquetas o para inhibir la activación de las plaquetas dependiente de la producción de tromboxano A2. Hasta el momento no hay ningún método general para la evaluación ex vivo de la activación plaquetaria o del grado de activación de las plaquetas después de la administración de aspirina, y los datos relativos al impacto clínico de la resistencia a la aspirina son conflictivos. Por esto, no es posible sugerir directrices específicas para el tratamiento de pacientes que muestran altos niveles de activación plaquetaria o un bajo nivel de inhibición de las plaquetas después del tratamiento con aspirina. El objetivo de esta revisión es presentar los datos de estudios clínicos y de laboratorio que están relacionadas con la resistencia a la aspirina y discutir las posibles causas, importancia clínica y formas de manejo clínico de dicha resistencia.
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