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How to optimise clopidogrel therapy? Reducing the low-response incidence by aggregometry-guided therapy modification
Horst Neubauer1, Sebastian Lask, Andreas Engelhardt
1Clinic of Cardiology & Angiology, St. Josef-Hospital / BG Kliniken Bergmannsheil, University Hospitals, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany. horst.neubauer@rub.de
Thrombosis and Haemostasis
|February 19, 2008
Summary
A new algorithm effectively reduces clopidogrel resistance in low responders (LR) by guiding treatment adjustments. This approach significantly lowers the incidence of clopidogrel resistance, improving patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis Research
Background:
- Clopidogrel resistance affects 5-30% of patients, increasing cardiovascular complication risk.
- Optimal therapeutic management for clopidogrel low responders (LR) remains undefined.
- Identifying and managing clopidogrel resistance is crucial for preventing adverse events.
Purpose of the Study:
- To evaluate a novel therapeutic algorithm for reducing clopidogrel resistance incidence.
- To assess the effectiveness of an aggregometer-guided approach in managing clopidogrel LR.
Main Methods:
- 161 patients undergoing coronary stenting received standard clopidogrel and aspirin therapy.
- Platelet responsiveness was assessed 48 hours post-loading dose using impedance aggregometry.
- Low responders were treated with a high-dose clopidogrel regimen or ticlopidine.
Main Results:
- 23.6% of patients were identified as clopidogrel low responders (LR).
- A P2Y12 receptor defect was found in 7.9% of LR.
- The algorithm reduced LR incidence from 23.6% to 5.0%, a 78.9% relative decrease.
Conclusions:
- An aggregometer-guided therapeutic algorithm effectively reduces clopidogrel resistance.
- This strategy improves clopidogrel responsiveness in low responders.
- The algorithm offers a promising approach to minimize clopidogrel resistance.
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