Early double stent thrombosis associated with clopidogrel hyporesponsivenesss

Abstract

A 57-year-old male patient without cardiovascular history suffered an acute myocardial infarction and underwent drug-eluting stent implantation in the left anterior descending artery. A few days later, the right coronary artery was also stented (drug-eluting stent). Three days later, he was re-admitted to our hospital in cardiogenic shock. Emergent coronary angiography showed total occlusion of both stents. Platelet function analysis (PFA) showed attenuated platelet inhibition in response to clopidogrel treatment. The patient was the carrier of a loss-of-function polymorphism in the CYP2C19 gene, which has been associated with increased incidence of adverse thrombotic events. Antiplatelet therapy was switched to prasugrel and PFA revealed an adequate antiplatelet effect.

Adoption of prasugrel into routine practice: rationale and design of the Rijnmond Collective Cardiology Research (CCR) study in percutaneous coronary intervention for acute coronary syndromes

“…Therefore, dual antiplatelet therapy with aspirin and a thienopyridine for the prevention of thrombotic complications is recommended in practice guidelines and represents the standard therapy, particularly in those undergoing percutaneous coronary intervention (PCI). Although clopidogrel has been the most widely used adenosine diphosphate (ADP) receptor inhibitor to date, pharmacodynamic interactions and genetic polymorphisms result in significant variability in the antiplatelet effect of clopidogrel [ 4 – 6 ], leading to the concern that some patients may be at increased risk for thrombotic events [ 7 – 9 ]. Such limitations prompted the search for alternative ADP receptor inhibitors that may provide more potent and more consistent platelet inhibition.…”