The Relation of Dosing to Clopidogrel Responsiveness and the Incidence of High Post-Treatment Platelet Aggregation in Patients Undergoing Coronary Stenting

Gurbel, Paul A.; Bliden, Kevin P.; Hayes, Kevin; Yoho, Jason A.; Herzog, William R.; Tantry, Udaya S.

doi:10.1016/j.jacc.2005.01.030

Cited by 351 publications

(236 citation statements)

References 17 publications

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“…Quantitative coronary angiography and PCI data. different studies [11][12][13]. This wide ranging variability is probably due to the lack of a standardized definition of the term "clopidogrel resistance".…”

Section: Discussionmentioning

confidence: 99%

Impact of cytochrome P450 2C19*2 polymorphism on the clinical cardiovascular events after stent implantation in patients receiving clopidogrel of a southern Tunisian region

Abid¹,

Laroussi²,

Bahloul³

et al. 2013

WJCD

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Introduction: The concept of clopidogrel resistance, first described in biology is being strengthened by recent data from clinical epidemiology. The cardiologists have been sensitized to this concept because of its possible involvement in the occurrence of coronary stent thrombosis. Purpose of the study: The purpose of this study was to investigate the genetic variant of the gene CYP 2C19 in our population and to assess the involvement of this genetic profile in the occurrence of major cardiovascular events (MACE) during the follow-up period. Methods: Our prospective study was conducted between May 2009 and September 2010 including 100 patients admitted to the cardiology department for percutaneous coronary stenting. The patients were divided into 2 groups: those with at least one CYP2C19*2 allele (*2 carriers) and noncarriers. Results: The mean age of our patients was 56.7 years ± 10, 5. No remarkable differences in the baseline characteristics were noted between the two groups. The prevalence of CYP2C19*2 allele in our population was 11.5%. Hospital mortality was estimated at 3%. No statistically significant differences were noted between the two groups regarding the occurrence of intra hospital MACE. The mean follow up was 7.5 ± 4.87 months for the entire study population. The rate of MACE during the follow-up of patients receiving clopidogrel was 8.2% throughout the study population: 5.3% in the *2 non-carriers versus 18.2% in the *2 carriers with a statistically significant difference (p = 0.075) at the risk of error of 10%. Concerning the occurrence of stent thrombosis, there was no significant statistical difference between the two study groups. Conclusion: From these results it is suggested that CYP2C19*2 polymorphism is associated with increase in the occurrence of MACE among Tunisian patients receiving clopidogrel. A larger study is needed to assess the role of genotyping in the evaluation of the phenomenon of clopidogrel resistance.

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Section: Discussionmentioning

confidence: 99%

Impact of cytochrome P450 2C19*2 polymorphism on the clinical cardiovascular events after stent implantation in patients receiving clopidogrel of a southern Tunisian region

Abid¹,

Laroussi²,

Bahloul³

et al. 2013

WJCD

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“…In addition, though slow onset of antiplatelet action could be overcome by the routine use of a loading dose, there is still a variability in its antiplatelet response. 24 Clopidogrel resistance, or the occurrence of events despite adequate dosage and patient compliance, has been observed in 4%-44% of patients with coronary artery disease. This variability is due in part to differences in patients tested and in part to differences in the definition of clopidogrel resistance.…”

Section: Discussionmentioning

confidence: 99%

“…Although a daily dose of 150 mg may be another solution, 26 it may be associated with a higher risk of bleeding complications. 24 A new antiplatelet agent (prasugrel), which is said to have more reliable antiplatelet action, is now in clinical trial. 27 Currently, we are aware of the variability of the antiplatelet action of clopidogrel manifested by occurrence of in-stent thrombosis in the neurointerventional arena.…”

Section: Discussionmentioning

confidence: 99%

Dual Antiplatelet Therapy Monitoring for Neurointerventional Procedures Using a Point-of-Care Platelet Function Test: A Single-Center Experience

Lee¹,

Arat²,

Morsi³

et al. 2008

AJNR Am J Neuroradiol

130

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“…Clopidogrel resistance was defined as either less than a 10% change in MPAR on d 5 or the MPAR (d 5) was greater than 50% of the baseline magnitude (d 0) [24,25] . The platelet …”

Section: Definition Of Clopidogrel Resistancementioning

confidence: 99%

Associations of CYP3A4, NR1I2, CYP2C19 and P2RY12 polymorphisms with clopidogrel resistance in Chinese patients with ischemic stroke

Zhou

Chen

et al. 2016

Acta Pharmacol Sin

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The Relation of Dosing to Clopidogrel Responsiveness and the Incidence of High Post-Treatment Platelet Aggregation in Patients Undergoing Coronary Stenting

Abstract: A 600-mg clopidogrel loading dose reduces the incidence of NR and high post-PA as compared to a 300-mg dose. Higher dosing strategies and methods to confirm platelet inhibition should be further investigated in order to optimally use clopidogrel in patients undergoing stenting.

Cited by 351 publications

References 17 publications

Impact of cytochrome P450 2C19*2 polymorphism on the clinical cardiovascular events after stent implantation in patients receiving clopidogrel of a southern Tunisian region

Impact of cytochrome P450 2C19*2 polymorphism on the clinical cardiovascular events after stent implantation in patients receiving clopidogrel of a southern Tunisian region

Dual Antiplatelet Therapy Monitoring for Neurointerventional Procedures Using a Point-of-Care Platelet Function Test: A Single-Center Experience

Associations of CYP3A4, NR1I2, CYP2C19 and P2RY12 polymorphisms with clopidogrel resistance in Chinese patients with ischemic stroke

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