Coronary stent thrombosis related to aspirin resistance: what are the underlying mechanisms?

Acute coronary stent thrombosis represents a serious complication for which aspirin resistance could be a potential cause. The actual case is a myocardial infarction treated with immediate stenting of the right coronary artery followed by elective stenting of the left anterior descending artery 4 days later. Despite standard antiplatelet therapy, stents in both arteries occluded 2 days after the last procedure. The patient's blood samples were analyzed and revealed the presence of aspirin resistance as well as elevated thromboxane B(2) plasma levels. No thrombophilic disorder was detected. Today the mechanism of aspirin resistance is mostly unknown. Further research as well as recommendations for laboratory screening and for alternative pharmacological treatment options are required.