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[Current options to manage clopidogrel poor responsiveness]

Luca Fileti1, Gianluca Campo, Marco Valgimigli

  • 1U.O. di Cardiologia, Azienda Ospedaliera Universitaria S. Anna, Ferrara.

Giornale Italiano Di Cardiologia (2006)
|March 2, 2011
PubMed

Insights

About 20% of patients on clopidogrel, an antiplatelet drug, are poor responders, increasing risks of death and heart attack. Management strategies like dose adjustments or switching medications can improve outcomes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Thrombosis

Background:

  • Antiplatelet therapy with aspirin and clopidogrel is standard for acute coronary syndromes and percutaneous coronary interventions (PCI).
  • Approximately 20% of the over 40 million global clopidogrel users exhibit poor response.
  • Poor responsiveness to clopidogrel is linked to higher risks of mortality, myocardial infarction, and stent thrombosis.

Purpose of the Study:

  • To review the clinical impact of poor clopidogrel responsiveness.
  • To explore the multifactorial mechanisms underlying clopidogrel non-response.
  • To discuss current and future management strategies for clopidogrel non-responders.

Main Methods:

  • Literature review of studies assessing clopidogrel responsiveness and clinical outcomes.
  • Analysis of mechanisms contributing to poor clopidogrel effect, including genetic and physiological factors.
  • Evaluation of diagnostic assays for assessing platelet reactivity.
  • Review of therapeutic interventions for managing non-responders.

Main Results:

  • Poor responders to clopidogrel face significantly increased risks of adverse cardiovascular events.
  • Mechanisms of non-response are diverse, involving genetics, platelet turnover, P2Y12 pathway activity, and drug interactions.
  • Various assays can quantify clopidogrel responsiveness, though definitions and methods vary.
  • Strategies such as dose escalation, switching to alternative agents (ticlopidine, prasugrel), or using glycoprotein IIb/IIIa inhibitors show potential benefits.

Conclusions:

  • Poor response to clopidogrel poses a significant clinical challenge with elevated risks.
  • Understanding the mechanisms of non-response is crucial for effective management.
  • Personalized therapeutic strategies are essential to optimize outcomes for patients with poor clopidogrel responsiveness.

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