Resistência ao clopidogrel: prevalência e variáveis associadas

Silva, Fabrício Braga da; Almeida, Gustavo Luiz Gouvêa de; Neno, Augusto; Kezen, José; Spelta, Milena; Godomiczer, Alessandra; Villela, Renato; Hellmuth, Bruno; Xavier, Sérgio Salles; Lins, Roberto Hugo da Costa

doi:10.1590/s0066-782x2012005000107

Cited by 9 publications

(7 citation statements)

References 29 publications

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“…The frequency of suboptimal PA inhibition observed during this study (14.9%) was similar to that previously reported (22–24). Interestingly, none of the patients receiving ticagrelor had inadequate PA inhibition.…”

Section: Discussionsupporting

confidence: 92%

Evaluation of platelet activity by multiple electrode impedance aggregometry in acute coronary syndromes: pilot study in a Brazilian tertiary-care public hospital

Lorenzo

Dutra

Mattos

et al. 2019

Braz J Med Biol Res

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There is no definite recommendation for testing platelet aggregation (PA) in acute coronary syndromes (ACS) due to inconclusive evidence on the usefulness of platelet function tests to guide therapy and improve clinical outcomes. The evaluation of PA with multiple electrode impedance platelet aggregometry (MEA) may be useful to manage antiplatelet therapy and possibly influence patient outcome. The primary aim of this study was to measure PA with MEA in Brazilian patients with ACS and evaluate the association between PA and adverse clinical outcomes. Forty-seven consecutive patients admitted with ACS to a Brazilian tertiary-care public hospital were studied and PA was evaluated using MEA. Patients were followed for six months for the occurrence of all-cause death, acute myocardial infarction, or stroke. Suboptimal inhibition of PA was found in 7 patients (14.9%); 5 (10.6%) in response to ASA (acetylsalicylic acid), 2 (5.0%) to clopidogrel, and none to ticagrelor. Inadequate PA inhibition in response to ASA was significantly associated with the composite end point, but there was no significant association for insufficient PA inhibition in response to clopidogrel. This study suggested that the evaluation of PA in ACS using MEA may identify non-responders to ASA. Larger studies are necessary to define, in a public health scenario, the value of MEA in the management of ACS.

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Section: Discussionsupporting

confidence: 92%

Evaluation of platelet activity by multiple electrode impedance aggregometry in acute coronary syndromes: pilot study in a Brazilian tertiary-care public hospital

Lorenzo

Dutra

Mattos

et al. 2019

Braz J Med Biol Res

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“…Laboratory ASA resistance is defined as the inability of therapeutic doses of ASA to inhibit platelet aggregation, which is a primary measurement of platelet function or a failure to reduce TXA 2 [ 17 ]. The incapacity of clopidogrel to inhibit platelet aggregation measured at the laboratory is known as clopidogrel resistance [ 18 ]. As Sibbing et al .…”

Section: Methodsmentioning

confidence: 99%

Antiplatelet resistance and the role of associated variables in stable patients treated with stenting

Uzun¹,

Bıyık

Aktürk³

et al. 2015

pwki

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IntroductionNowadays, clopidogrel and acetylsalicylic acid (ASA) have become routinely applied therapies in percutaneous coronary interventions (PCI) with stenting.AimNumerous variables can interfere with antiplatelet responsiveness, so we aimed to investigate the role of different variables associated with ASA or clopidogrel resistance in stable coronary artery disease.Material and methodsA total of 207 patients undergoing elective PCI were included in the analysis. All patients received a loading dose of clopidogrel and ASA during PCI procedure and followed by dual antiplatelet therapy. Clopidogrel and ASA resistance were measured by impedance aggregometry method.ResultsOf the patients, 19.8% had clopidogrel resistance, 18.8% had ASA resistance, 9.2% had both clopidogrel and ASA resistance, and 71.5% were responsive to both drugs. In multivariate analysis, platelet count, angiotensin receptor blocker (ARB) use, and ASA resistance were independent variables associated with clopidogrel resistance, and clopidogrel resistance was the only variable associated with ASA resistance. In differentiating whether clopidogrel resistance exists or not, optimum ASA aggregometry response cut-off values were specified, and in differentiating whether ASA resistance exists or not, optimum clopidogrel aggregometry response cut-off values were specified.ConclusionsIn this study, there was a higher incidence of low responsiveness to ASA when there was a low response to clopidogrel, and vice versa. Angiotensin receptor blocker use, platelet count, and ASA resistance were independent variables associated with clopidogrel resistance. Clopidogrel resistance was the only independent variable associated with ASA resistance. Angiotensin receptor blocker use seems to an independent risk factor for clopidogrel resistance in this study, but this result needs to be verified in other studies.

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“…Patients with coronary ischemia who are nonresponders to clopidogrel and aspirin are at greater risk of subsequent ischemic vascular events and death [ 14 ]. Several studies have shown that reduced response to clopidogrel ranges from 4.8–51% [ 15 , 16 ]. Our previous studies showed that the incidence of CR in the Chinese population was 40%, and CR was associated with RIS during 6 months after stroke [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Response to clopidogrel is associated with early neurological deterioration after acute ischemic stroke

Lin

Wang

et al. 2018

Oncotarget

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PurposeThe relationship between response to clopidogrel and early neurological deterioration (END) after acute ischemic stroke (IS) is not well defined. The aim of present study was to evaluate the associations of clopidogrel resistance (CR) with END, and stratified analyze the effectiveness of clopidogrel alone and clopidogrel plus aspirin for the prevention of END.ResultsA total of 375 patients, 144 patients were received clopidogrel alone, 231 patients took clopidogrel plus aspirin. CR occurred in 153 patients (40.8%). 95 (25.3%) patients developed END within the first 10 days. Platelet aggregation was higher on admission, and inhibition of platelet aggregation was significantly lower in patients with END than patients without END. Diabetes mellitus, CR, and clopidogrel plus aspirin were independently associated with END. Dual antiplatelet therapy with aspirin and clopidogrel can inhibit both arachidonic acid (AA)-induced and ADP-induced platelet aggregationMethodsThis was a prospective, two-center study. A total of 375 IS patients taking clopidogrel alone or clopidogrel plus aspirin were enrolled. Platelet aggregation was measured before and after the 7–10 day treatment. CR was assessed by adenosine diphosphate (ADP)-induced platelet aggregation. The primary endpoint was END within the 10 days after admission. The secondary endpoint was a composite of recurrent ischemic stroke, myocardial infarction, and death during the 10 days after admission.ConclusionsCR and END are fairly common after acute IS. CR is associated with higher risk of END. Clopidogrel plus aspirin combination therapy provides greater inhibition of platelet aggregation, and may afford protection against END.

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Resistência ao clopidogrel: prevalência e variáveis associadas

Cited by 9 publications

References 29 publications

Evaluation of platelet activity by multiple electrode impedance aggregometry in acute coronary syndromes: pilot study in a Brazilian tertiary-care public hospital

Evaluation of platelet activity by multiple electrode impedance aggregometry in acute coronary syndromes: pilot study in a Brazilian tertiary-care public hospital

Antiplatelet resistance and the role of associated variables in stable patients treated with stenting

Response to clopidogrel is associated with early neurological deterioration after acute ischemic stroke

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