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Suspected clopidogrel resistance in a patient with acute stent thrombosis

Hemender S Vats1, William G Hocking, Shereif H Rezkalla

  • 1Marshfield Clinic, Marshfield, WI 54449, USA.

Nature Clinical Practice. Cardiovascular Medicine
|March 29, 2006
PubMed

Insights

A patient experienced acute stent thrombosis and myocardial infarction despite clopidogrel therapy, indicating potential clopidogrel resistance. This case highlights the need for further investigation into antiplatelet therapy effectiveness in complex coronary interventions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • A 67-year-old male with supraventricular tachycardia and angina underwent coronary angiography.
  • Mild left main coronary artery disease and significant left intermediate artery stenosis were identified.
  • A drug-eluting stent was implanted, with treatment initiated using clopidogrel and eptifibatide.

Observation:

  • The patient developed acute myocardial infarction, characterized by chest pain, hypotension, and hypoxemia.
  • Emergency angiography revealed occlusion of the left intermediate artery, despite ongoing clopidogrel treatment.

Findings:

  • Diagnosis of acute stent thrombosis and suspected clopidogrel resistance was made.
  • Platelet function tests and hypercoagulable workup were performed.
  • Management involved warfarin, aspirin, and clopidogrel therapy.

Implications:

  • This case underscores the possibility of clopidogrel resistance in patients undergoing percutaneous coronary intervention.
  • It emphasizes the importance of considering alternative or additional antiplatelet strategies in cases of stent thrombosis.
  • Further research into personalized antiplatelet therapy based on platelet function testing is warranted.
Abstract

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