High Antiplatelet Resistance, Elevated von Willebrand Factor in Vascular Surgery Patients

Patients undergoing major non-cardiac vascular surgery often carry a high burden of cardiovascular risk, making antiplatelet therapy essential for preventing thrombotic events [1, 2]. Agents like aspirin and clopidogrel are mainstays for conditions such as peripheral arterial disease, which frequently necessitates surgical intervention [3, 4]. However, managing these medications peri-operatively creates a clinical dilemma: balancing the prevention of myocardial infarction and stroke against the risk of surgical bleeding [1, 5]. While guidelines often recommend a temporary hold on antiplatelet agents, significant individual variability in drug response complicates this strategy [4]. A recent prospective study provides new data on the prevalence of antiplatelet resistance and the effectiveness of current discontinuation protocols in this high-risk population.