Variable extent of platelet responsiveness to clopidogrel inhibition: "clopidogrel resistance"?

During percutaneous coronary angioplasty, platelet inhibition by clopidogrel and aspirin has drastically decreased the risk of thrombotic occlusion of the stented vessels. However, despite the widespread use of these drugs, the incidence of acute or subacute stent thrombosis remains elevated, concer...

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Veröffentlicht in:Annales de cardiologie et d'angéiologie 2005-08, Vol.54 (4), p.194-200
Hauptverfasser: Morel, O, Ohlmann, P, Jesel, L, Morel, N, Ridard, C, Faure, A, Grunebaum, L, Toti, F, Bareiss, P
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container_issue 4
container_start_page 194
container_title Annales de cardiologie et d'angéiologie
container_volume 54
creator Morel, O
Ohlmann, P
Jesel, L
Morel, N
Ridard, C
Faure, A
Grunebaum, L
Toti, F
Bareiss, P
description During percutaneous coronary angioplasty, platelet inhibition by clopidogrel and aspirin has drastically decreased the risk of thrombotic occlusion of the stented vessels. However, despite the widespread use of these drugs, the incidence of acute or subacute stent thrombosis remains elevated, concerning 1 to 2% of the treated patients. Considerable differences in the responsiveness to clopidogrel could be observed, suggesting a possible underlying biological resistance. "Clopidogrel resistance" has recently been associated to an increased risk of thrombotic events following coronary angioplasty. Variations in enteric absorption, biotransformation in the liver by the CYP3A4, changes in the ADP receptor P2Y12, abnomalies of intraplatelet signal transduction, extent of platelet activation, class angina, diabetes mellitus may account for the considerable interindividual response variability widely reported. In this view, laboratory tests evaluating "clopidogrel resistance" might be useful tools for the identification and follow-up of patients at higher thrombotic risk. Indeed, in these patients, further platelet inhibition can be achieved by higher doses of clopidogrel.
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subjects Angioplasty, Balloon
Dose-Response Relationship, Drug
Drug Resistance
Humans
Platelet Aggregation Inhibitors - therapeutic use
Polymorphism, Genetic
Receptors, Purinergic P2 - genetics
Thrombosis - prevention & control
Ticlopidine - analogs & derivatives
Ticlopidine - therapeutic use
title Variable extent of platelet responsiveness to clopidogrel inhibition: "clopidogrel resistance"?
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