A Systematic Review of Clopidogrel Resistance in Vascular Surgery: Current Perspectives and Future Directions

Kim, Young; Weissler, E. Hope; Pack, Neena; Latz, Christopher A.

doi:10.1016/j.avsg.2022.12.071

Cited by 10 publications

(4 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Antiplatelet resistance is not limited to CABG surgery alone. This resistance contributes to poor clinical outcomes in cardiovascular disease, whether managed medically or through percutaneous coronary interventions, as well as in cerebrovascular diseases, including stroke and neuro-interventional procedures [ 37 , 41 – 43 ]. A comprehensive meta-analysis including 2,930 patients demonstrated that antiplatelet resistance is associated with a significantly higher incidence of cardiovascular events (odds ratio (OR): 3.85; 95% confidence interval (CI): 3.08–4.80) and mortality (OR: 5.99; 95% CI: 2.28–15.72) [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Antiplatelet Resistance in Coronary Artery Bypass Grafting: A Systematic Review

Thet,

Khosravi,

Egbulonu

et al. 2024

Surgery Research and Practice

View full text Add to dashboard Cite

Background. This systematic review examines the occurrence and implications of resistance to primary antiplatelet agents, aspirin and clopidogrel, often utilised in patients undergoing coronary artery bypass grafting (CABG), alongside the methodologies for assessment of such resistance. Methods. An extensive literature search across various databases such as PubMed, MEDLINE via Ovid, Embase, and Cochrane CENTRAL until May 2024 was conducted to identify studies evaluating antiplatelet resistance in on‐pump and off‐pump CABG patients. Following quality assessment, only high‐quality studies were incorporated into this review. Results. This review included 19 studies with 3,915 patients, four of which were randomised controlled trials and 15 were observational studies. Aspirin resistance incidence ranged from 11.0% to 51.5%, while clopidogrel resistance was 22%. Antiplatelet resistance, assessed through a wide variety of methods, was associated with a 13 times increase in the risk of vein graft occlusion and increased rates of mortality, myocardial infarction, and target vessel revascularisation in the case of clopidogrel resistance. The effect of cardiopulmonary bypass on antiplatelet resistance remains ambiguous. Conclusion. The academic literature lacks a standardised definition for antiplatelet resistance. Assessment methodologies greatly vary, leading to noninterchangeable outcomes. While aspirin resistance has a conflicting overall significant impact on adverse outcomes, clopidogrel resistance correlates with poorer clinical outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Antiplatelet Resistance in Coronary Artery Bypass Grafting: A Systematic Review

Thet,

Khosravi,

Egbulonu

et al. 2024

Surgery Research and Practice

View full text Add to dashboard Cite

show abstract

“…vasodilator-stimulated phosphoprotein phosphorylation (VASP) assay since recent meta-analysis described a significant impact of clopidogrel resistance in vascular and endovascular surgery. 33 Such approach may further minimize the risk for SMCD failure in patients with DAPT.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Determinants for Suture-mediated Closure Device Failure During EVAR Procedures

Garabet,

Arnautovic,

Meurer

et al. 2023

Vasc Endovascular Surg

View full text Add to dashboard Cite

Objective Endovascular aortic repair (EVAR) for elective and emergency infrarenal aortic pathologies is the primary approach for treatment nowadays. During such procedure, the suture-mediated closure device (SMCD) (Perclose ProGlideTM, Abbott Laboratories, Chicago, IL, USA) is commonly used. This study aimed to identify potential contributors for SMCD failure in a patient cohort of elective and emergency EVAR. Methods Archived medical records from patients who underwent EVAR for aortic pathologies in elective and emergency setting at the University Hospital Düsseldorf, Germany were included. Patient’s co-morbidities, access vessel morphologies and hemostasis-related blood parameters were evaluated on their association with SMCD failure applying different statistical methods. Results A total of 71 patients (139 femoral accesses) was included. The mean age was 73.5 ± 8.4 years. Overall SMCD failure rate was 4.3%, 4.1% for elective and 5.9% for emergency cases, respectively. Total procedure time was longer for the SMCD failure group (323 ± 117.8 min vs 171 ± 43.7 min). The calcification status of the common femoral artery (CFA), the diameter of the aortic bifurcation, and dual anti-platelet therapy (DAPT) on the medication plan prior to the procedure were associated with SMCD failure. Univariate binary logistic regression analysis nominated several potentially relevant predictors for SMCD failure who underwent subsequent multivariable binary logistic regression analysis. Here, DAPT on the medication plan was identified as being promising in predicting SMCD failure (OR 30.5), while anterior plaque formation in the CFA maintained as only statistically relevant determinant (OR 44.9). Conclusions This study confirms the CFA calcification status to be associated with SMCD failure. Although discontinued prior to endovascular treatment, DAPT was also found to be associated with SMCD failure. Our results may advocate to perform obligatory platelet testing prior to EVAR to maximize patient safety.

show abstract

“…Resistance to clopidogrel (HPR), empirically defined as <10% reduction in platelet LTA-ADP, is expected to be observed in about 10-15% of patients (8). Several mechanisms mediating clopidogrel resistance have been described (9). Clopidogrel is metabolized into its actives compounds by the hepatic cytochrome 450 2C19 (CYP2C19), whose activity is modulated by genetic polymorphisms (10) and numerous pharmacological interactions (11).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“… 8 Several mechanisms mediating clopidogrel resistance have been described. 9 Clopidogrel is metabolized into its actives compounds by the hepatic cytochrome 450 2C19 (CYP2C19), whose activity is modulated by genetic polymorphisms 10 and numerous pharmacological interactions. 11 Besides metabolism, a decreased gastrointestinal adsorption of clopidogrel might affect the plasmatic concentration of its active metabolites.…”

Section: Introductionmentioning

confidence: 99%

Identification of High Platelet Reactivity Despite ADP P2Y12 Inhibitor Treatment: Two Populations in the Vasodilator-Stimulated Phosphoprotein Assay and Variable PFA-P2Y Shapes of Curve

Mariethoz

Scala

Matthey‐Guirao

et al. 2023

TH Open

View full text Add to dashboard Cite

Introduction Response to ADP P2Y12 receptor inhibition by clopidogrel can be evaluated by various techniques. Here, we compared a functional rapid point-of-care technique (PFA-P2Y®) with the degree of biochemical inhibition assessed by the VASP/P2Y12® assay. Methods Platelet response to clopidogrel was investigated in 173 patients undergoing elective intracerebral stenting (derivation cohort n=117; validation cohort n=56). High platelet reactivity (HPR) was defined as PFA-P2Y® occlusion time <106 sec or VASP/P2Y12® platelet reactivity index (PRI) >50%. Results In the derivation cohort, ROC analysis for the ability of PFA-P2Y® to detect biochemical HPR showed high specificity (98.4%) but poor sensitivity (20.0%) and a very low AUC (0.59). The VASP/P2Y12® assay revealed two coexisting platelet populations with different levels of VASP phosphorylation: a fraction of highly phosphorylated, inhibited platelets and another of poorly phosphorylated, reactive platelets. Analysis of the PFA-P2Y® curve shape revealed different types, categorized by time of occlusion (<106 sec, 106-300 sec, >300 sec) and pattern (regular, irregular, atypical). Noteworthy, curves with late occlusion and permeable curves with an irregular or atypical pattern correlated with VASP-PRI >50% and smaller sizes of the inhibited platelet sub-population. Considering the PFA-P2Y® shape of curve for the detection of HPR improved sensitivity (72.7%) and preserved specificity (91.9%), with a rather high AUC (0.823). The validation cohort confirmed the VASP/P2Y12® assay data and the usefulness of considering the PFA-P2Y® curve shape. Conclusion In patients treated with acetyl-salicylic acid and clopidogrel for 7-10 days, the VASP/P2Y12® assay reveals two coexisting sub-populations of differentially inhibited platelets, whose relative sizes predict global PRI and distinct PFA-P2Y® curve patterns. The detailed analysis of both VASP/P2Y12® and PFA-P2Y® is necessary for an optimal detection of HPR.

show abstract

A Systematic Review of Clopidogrel Resistance in Vascular Surgery: Current Perspectives and Future Directions

Cited by 10 publications

References 51 publications

Antiplatelet Resistance in Coronary Artery Bypass Grafting: A Systematic Review

Antiplatelet Resistance in Coronary Artery Bypass Grafting: A Systematic Review

Analysis of Determinants for Suture-mediated Closure Device Failure During EVAR Procedures

Identification of High Platelet Reactivity Despite ADP P2Y12 Inhibitor Treatment: Two Populations in the Vasodilator-Stimulated Phosphoprotein Assay and Variable PFA-P2Y Shapes of Curve

Contact Info

Product

Resources

About