Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity.
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TLDR
Interindividual variability in the platelet inhibitory response from clopidogrel occurs in patients undergoing elective coronary stenting, and patients with high pretreatment reactivity are least protected.Abstract:
Background— Clopidogrel is administered to prevent stent thrombosis; however, the uniformity of platelet inhibition after treatment and the influence of pretreatment reactivity on drug response have not been described. Methods and Results— Platelet aggregation (5 and 20 μmol/L ADP), the activation of glycoprotein IIb/IIIa (PAC-1 antibody), and the expression of P-selectin were measured in patients undergoing elective coronary stenting (n=96) at baseline and at 2 hours, 24 hours, 5 days, and 30 days after stenting. All patients received aspirin (325 mg). Clopidogrel (300 mg) was administered in the catheterization laboratory and followed by 75 mg daily. There was marked interindividual variability in drug response as measured by all markers that showed a normal distribution. Resistance, defined as baseline aggregation (%) minus posttreatment aggregation (%) ≤10% by 5 μmol/L ADP, was present in 31% and 15% of patients at 5 and 30 days, respectively. Patients with the highest pretreatment platelet reactivity...read more
Citations
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Cytochrome P-450 Polymorphisms and Response to Clopidogrel
Jessica L. Mega,Sandra L Close,Stephen D. Wiviott,Lei Shen,Richard D. Hockett,John T. Brandt,Joseph R. Walker,Elliott M. Antman,William L. Macias,Eugene Braunwald,Marc S. Sabatine +10 more
TL;DR: Carriers of a reduced-function CYP2C19 allele had significantly lower levels of the active metabolite of clopidogrel, diminished platelet inhibition, and a higher rate of major adverse cardiovascular events, including stent thrombosis, than did noncarriers.
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Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes
J.-P Bassand,Christian W. Hamm,Diego Ardissino,Eric Boersma,A Budaj,Francisco Fernández-Avilés,Keith A.A. Fox,David Hasdai,Erik Magnus Ohman,Lars Wallentin,William Wijns +10 more
TL;DR: Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim to assist physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means.
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Association of Cytochrome P450 2C19 Genotype With the Antiplatelet Effect and Clinical Efficacy of Clopidogrel Therapy
Alan R. Shuldiner,Jeffrey R. O'Connell,Kevin P. Bliden,Amish Gandhi,Kathleen A. Ryan,Richard B. Horenstein,Coleen M. Damcott,Ruth E. Pakyz,Udaya S. Tantry,Quince Gibson,Toni I. Pollin,Wendy S. Post,Afshin Parsa,Braxton D. Mitchell,Nauder Faraday,William R. Herzog,Paul A. Gurbel +16 more
TL;DR: CYP2C19*2 genotype was associated with diminished platelet response to clopidogrel treatment and poorer cardiovascular outcomes, and patients with the CYP2C 19*2 variant were more likely to have a cardiovascular ischemic event or death during 1 year of follow-up.
Journal ArticleDOI
Clopidogrel Resistance Is Associated With Increased Risk of Recurrent Atherothrombotic Events in Patients With Acute Myocardial Infarction
Shlomi Matetzky,Boris Shenkman,Victor Guetta,Michael Shechter,Roy Beinart,Ilan Goldenberg,Ilya Novikov,Hanna Pres,Naphtali Savion,David Varon,Hanoch Hod +10 more
TL;DR: Up to 25% of STEMI patients undergoing primary PCI with stenting are resistant to clopidogrel and therefore may be at increased risk for recurrent cardiovascular events.
Journal ArticleDOI
Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial.
Matthew J. Price,Peter B. Berger,Paul S. Teirstein,Jean-François Tanguay,Dominick J. Angiolillo,Douglas Spriggs,Sanjeev Puri,Mark Robbins,Kirk N. Garratt,Olivier F. Bertrand,Michael E. Stillabower,Joseph Aragon,David E. Kandzari,Curtiss T. Stinis,Michael S. Lee,Steven V. Manoukian,Christopher P. Cannon,Nicholas J. Schork,Eric J. Topol +18 more
TL;DR: In this paper, the authors evaluated the effect of high-dose compared with standard-dose clopidogrel in patients with high on-treatment platelet reactivity after percutaneous coronary intervention (PCI), but a treatment strategy for this issue was not well defined.
References
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Journal ArticleDOI
Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation.
Salim Yusuf,Zhao F,Shamir R. Mehta,Susan Chrolavicius,Gianni Tognoni,K K Fox,Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators +6 more
TL;DR: The antiplatelet agent clopidogrel has beneficial effects in patients with acute coronary syndromes without ST-segment elevation, however, the risk of major bleeding is increased among patients treated with clopIDogrel.
Journal Article
A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events(CAPRIE).
TL;DR: Long-term administration of clopidogrel to patients with atherosclerotic vascular disease is more effective than aspirin in reducing the combined risk of ischaemic stroke, myocardial infarction, or vascular death.
Journal Article
A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee
TL;DR: The CAPRIE trial as discussed by the authors evaluated the relative efficacy of clopidogrel and aspirin in reducing the risk of a composite outcome cluster of ischaemic stroke, myocardial infarction, or vascular death; their relative safety was also assessed.
Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without st-segment elevation
TL;DR: The antiplatelet agent clopidogrel has beneficial effects in patients with acute coronary syndromes without ST-segment elevation, however, the risk of major bleeding is increased among patients treated with clopIDogrel.
Journal ArticleDOI
Detection of activated platelets in whole blood using activation- dependent monoclonal antibodies and flow cytometry
TL;DR: It is demonstrated that activated platelets can be reliably detected in whole blood using activation-dependent monoclonal antibodies and flow cytometry and may be useful to assess the degree of platelet activation and the efficacy of antiplatelet therapy in clinical disorders.