By Stephen D. Wiviott
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Additional resources for Antiplatelet Therapy In Ischemic Heart Disease (American Heart Association Clinical Series)
The antithrombotic effect of aspirin is resultant from the decreased production of TXA2, a potent vasoconstrictor and platelet agonist. The Antithrombotic Trialists’ Collaboration reported that aspirin therapy was associated with 15% reduction in vascular mortality, 34% reduction in myocardial infarction, and 25% reduction in stroke among high-risk patients with atherothrombotic disease . Aspirin has also been shown to reduce the acute ischemic complications of coronary angioplasty [3–5]. While the benefits of aspirin are widely accepted, cardiovascular events may still occur in patients treated with aspirin.
6). Comparison of the VASP assay with ADP-induced turbidometric platelet aggregation demonstrated that the level of thienopyridine-induced inhibition is higher in the VASP assay, presumably because platelet aggregation can still occur via ADP stimulation of P2Y1 in the presence of a thienopyridine . Patients with a poorer platelet response to clopidogrel, as determined by the VASP assay, have been reported to have a higher incidence of subacute stent thrombosis . Platelet surface P-selectin and/or the activated conformation of platelet surface GP IIb/IIIa (reported by monoclonal antibody PAC1) can also be measured by whole blood flow cytometry .
Pharmacodynamics ASA irreversibly inhibits the initial committed step of prostanoid biosynthesis by preventing the conversion of AA to PGG2 by COX-1 and COX-2. ASA initially binds an arginine 120 residue, a common docking site for all NSAIDs, after which it acetylates a COX serine residue . In the human COX-1 enzyme, serine is acetylated at position 529 whereas in COX-2 this occurs at position 516 . Acetylation of the serine residue by ASA stops AA from accessing the catalytic site of the COX  and prevents formation of the downstream prostanoids.
Antiplatelet Therapy In Ischemic Heart Disease (American Heart Association Clinical Series) by Stephen D. Wiviott