Clopidogrel for Coronary Stenting

Gurbel, Paul A.; Bliden, Kevin P.; Hiatt, Bonnie L.; O’Connor, Christopher M.

doi:10.1161/01.cir.0000072771.11429.83

Cited by 1,405 publications

(414 citation statements)

References 20 publications

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“…Previous studies have demonstrated that suboptimal response to antiplatelet agents was affected by many factors 18, 19. Simple linear regression analysis showed that the inhibitory rate of ADP pathway may be associated with age, sex, OSA, hypertension, eGFR, platelet counts and β‐blockers ( P <0.1) (Table S1).…”

Section: Resultsmentioning

confidence: 91%

“…Suboptimal response to antiplatelet agents or HRPR, in fact, has been associated with an enhanced risk of major cardiovascular events and acute ischemic complications, especially with clopidogrel, where a high HRPR has been described in almost 30% of patients 18, 25, 26. In patients with ACS or undergoing PCI, HRPR is associated with ≈2‐ to 3‐fold greater risk of recurrent ischemic events and about 1.5‐fold greater risk of all‐cause mortality 27, 28, 29.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Obstructive Sleep Apnea on Platelet Function Profiles in Patients With Acute Coronary Syndrome Taking Dual Antiplatelet Therapy

Gong

Xiao

Fan

et al. 2018

JAHA

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BackgroundObstructive sleep apnea (OSA) is a novel risk factor for acute coronary syndrome (ACS). Several studies have shown OSA to be associated with induced platelet reactivity. However, whether OSA have effects on platelet function profiles in ACS patients taking dual antiplatelet therapy remains unexplored.Methods and ResultsThis was a cross‐sectional observational study, in which ACS patients taking maintenance aspirin and clopidogrel therapy were included. OSA was defined as an apnea‐hypopnea index ≥15 events/hour. The inhibitory rate of arachidonic acid or adenosine diphosphate pathway were assessed with thrombelastography and defined patients with high residual on‐treatment platelet reactivity. Platelet indices were obtained from routine analysis of blood samples using an automated blood cell counter. A total of 127 ACS patients taking dual antiplatelet therapy were analyzed. Platelet volume indices, including mean platelet volume and platelet large cell ratio, were significantly increased in patients with OSA. Patients with OSA (n=68) had significantly lower inhibitory rate of adenosine diphosphate receptor pathway (P=0.028) compared with those without (n=59). After adjustment for potential confounders, patients with OSA were more likely to have high residual on‐treatment platelet reactivity after clopidogrel therapy (adjusted odds ratio: 3.25, 95% confidence interval: 1.19–8.87, P=0.021).ConclusionsIn ACS patients taking dual antiplatelet therapy, OSA is associated with an increased level of platelet volume indices, reduced clopidogrel‐induced antiplatelet effects and a greater prevalence of high residual on‐treatment platelet reactivity.

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Section: Resultsmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Impact of Obstructive Sleep Apnea on Platelet Function Profiles in Patients With Acute Coronary Syndrome Taking Dual Antiplatelet Therapy

Gong

Xiao

Fan

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…16 Clopidogrel hyporesponsiveness appears to increase the risk for thrombotic events, particularly in patients undergoing PCI. 17 For instance, the previously mentioned study by Matetzky and colleagues found an increased likelihood of recurrent cardiovascular events among patients with STsegment elevation myocardial infarction (STEMI) who were hyporesponsive to clopidogrel and underwent PCI.…”

Section: Clopidogrelmentioning

confidence: 99%

Investigating the Mechanisms of Hyporesponse to Antiplatelet Approaches

et al. 2008

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Hyporesponsiveness, or resistance, to antiplatelet therapy may be a major contributor to poorer outcomes among cardiac patients and may be attributed to an array of mechanisms—both modifiable and unmodifiable. Recent evidence has uncovered clinical, cellular, and genetic factors associated with hyporesponsiveness. Patients with severe acute coronary syndromes (ACS), type 2 diabetes, and increased body mass index appear to be the most at risk for hyporesponsiveness. Addressing modifiable mechanisms may offset hyporesponsiveness, while recognizing unmodifiable mechanisms, such as genetic polymorphisms and diseases that affect response to antiplatelet therapy, may help identify patients who are more likely to be hyporesponsive. Hyporesponsive patients might benefit from different dosing strategies or additional antiplatelet therapies. Trials correlating platelet function test results to clinical outcomes are required. Results from these studies could cause a paradigm shift toward individualized antiplatelet therapy, improving predictability of platelet inhibition, and diminishing the likelihood for hyporesponsiveness. Copyright © 2008 Wiley Periodicals, Inc.

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“…In an initial study designed to examine the uniformity of platelet inhibition by a clopidogrel 300 mg loading dose followed by a 75 mg/day maintenance dose in patients undergoing stenting, platelet function was measured by aggregation and the expression of activation-dependent receptor expression. 1 A normal distribution of response was demonstrated for both measurements. Using a cutpoint of <10% absolute change in aggregation for resistance, the prevalence of resistance was about 50%-60% at 2 h; about 30% at 1 and 5 days; and 15%-21% at 30 days after stenting.…”

Section: Optimizing Clopidogrel Dosingmentioning

confidence: 74%

Clinical Considerations with the Use of Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention

et al. 2008

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Despite the proven benefits of using antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI), a number of key questions remain to be answered. In recent years, clopidogrel dosing strategies among such patients have evolved considerably, with newer approaches involving loading doses prior to PCI and increases in the time interval and loading dosage in an effort to overcome variable responsiveness/hyporesponsiveness to platelet inhibition. Further, the role of glycoprotein (GP) IIb/IIIa antagonists in elective stenting continues to be defined, with recent evidence suggesting that most appropriate use of these agents is in high‐risk patients with elevated troponin levels. There appears to be a relationship between the use of GP IIb/IIIa antagonists with clopidogrel loading and attenuation of early inflammatory and cardiac marker release. Strategies to minimize the chance of late stent thrombosis in patients who receive drug‐eluting stents (DES) are also under intense investigation. Among some patients receiving sirolimus and paclitaxel DES, current standard long‐term antiplatelet strategies may be insufficient. Patient nonadherence to treatment and premature discontinuation and underutilization of antiplatelet therapies by physicians remain important clinical problems with potentially dire consequences. Copyright © 2008 Wiley Periodicals, Inc.

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Clopidogrel for Coronary Stenting

Cited by 1,405 publications

References 20 publications

Impact of Obstructive Sleep Apnea on Platelet Function Profiles in Patients With Acute Coronary Syndrome Taking Dual Antiplatelet Therapy

Impact of Obstructive Sleep Apnea on Platelet Function Profiles in Patients With Acute Coronary Syndrome Taking Dual Antiplatelet Therapy

Investigating the Mechanisms of Hyporesponse to Antiplatelet Approaches

Clinical Considerations with the Use of Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention

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