Failure of high-dose clopidogrel in recurrent stent thrombosis

This case report describes recurrent drug-eluting stent thrombosis with documented laboratory hyporesponsiveness to clopidogrel. The use of escalating doses of clopidogrel prevented subsequent episodes, but the patient developed gastrointestinal intolerance and diffuse cutaneous reaction, which resolved completely with prasugrel. Impressively, prasugrel 10 mg daily achieved an even lower vasodilator-stimulated phosphoprotein platelet reactivity index compared to clopidogrel 300 mg daily. Our case highlights the importance of alternative P2Y12 receptor antagonists for patients receiving drug-eluting stents.