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Related Experiment Videos

The difference between clopidogrel responsiveness and posttreatment platelet reactivity.

Waiel M Samara1, Kevin P Bliden, Udaya S Tantry

  • 1Sinai Center for Thrombosis Research, Hoffberger Building, Suite 56, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.

Thrombosis Research
|November 30, 2004
PubMed
Summary

Clopidogrel responsiveness may not accurately predict thrombotic risk. Posttreatment platelet reactivity, not just responsiveness, is a better indicator of risk in patients undergoing coronary stenting.

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Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Hematology

Background:

  • Platelet aggregation is a key measure of platelet reactivity.
  • Clopidogrel responsiveness is typically estimated by comparing pre- and post-treatment platelet aggregation.
  • Some patients responsive to clopidogrel may still exhibit high platelet reactivity, increasing thrombotic risk.

Purpose of the Study:

  • To evaluate the relationship between clopidogrel responsiveness and actual posttreatment platelet reactivity.
  • To determine if posttreatment platelet reactivity is a more accurate predictor of thrombotic risk than clopidogrel responsiveness alone.

Main Methods:

  • Adenosine diphosphate (ADP)-induced platelet aggregation was measured in 62 patients before and 5 days after elective coronary stenting.

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  • Patients received aspirin and a loading dose of clopidogrel, followed by daily maintenance doses.
  • Clopidogrel responsiveness was categorized into nonresponders (<10% inhibition), semiresponders (10-30%), and responders (>30%) based on relative aggregation inhibition.

    • Main Results:

    • Pretreatment platelet reactivity was categorized into low, moderate, and high tertiles.
    • Clopidogrel responsiveness correlated with pretreatment reactivity; responders often had moderate to high pretreatment reactivity.
    • A significant proportion of patients, even those considered responsive, maintained moderate posttreatment platelet reactivity.

    Conclusions:

    • Assessing clopidogrel responsiveness alone may inaccurately estimate thrombotic risk, potentially overestimating risk in nonresponders and underestimating it in responders with persistent high reactivity.
    • Posttreatment platelet reactivity is a more reliable indicator of thrombotic risk compared to clopidogrel responsiveness in patients undergoing coronary stenting.