Impact of clopidogrel response on the clinical evolution in patients with acute coronary syndromes
Irina Iuliana Costache1, Cristina Rusu, I Ivanov
1University of Medicine and Pharmacy Grigore T Popa Iasi, Faculty of Medicine.
Insights
Genetic testing reveals Clopidogrel response impacts acute coronary syndrome outcomes. High responders face bleeding risks, while low or unpredictable responders experience worse clinical events like angina recurrence.
Area of Science:
- Cardiology
- Pharmacogenomics
- Clinical Medicine
Background:
- Acute coronary syndromes (ACS) require antiplatelet therapy.
- Clopidogrel is a common antiplatelet agent used in ACS management.
- Individual responses to Clopidogrel can vary, impacting treatment efficacy and safety.
Purpose of the Study:
- To investigate the relationship between Clopidogrel genetic response and patient outcomes in acute coronary syndromes.
- To identify potential correlations between Clopidogrel metabolism and adverse clinical events.
Main Methods:
- Study included 80 patients diagnosed with acute coronary syndromes.
- Patients received Clopidogrel, with or without aspirin.
- Clopidogrel resistance was assessed using specific genetic laboratory tests.
Main Results:
- 5% were normal responders, 3.75% low responders, 72.5% high responders, and 18.75% unpredictable.
- High responders exhibited a significant incidence of hemorrhagic disorders.
- Low and unpredictable responders frequently experienced angina recurrence and left ventricular failure.
Conclusions:
- A positive correlation exists between high Clopidogrel response and hemorrhagic events.
- Poor responders or those with unpredictable responses to Clopidogrel face worse outcomes, including angina recurrence and heart failure.
Aim:
the purpose of the present study was to determine the relationship between the Clopidogrel genetic response (based on laboratory specific tests) and the worse evolution of the patients with acute coronary syndromes.
Material And Methods:
The study included 80 patients (11 females and 69 males), aged between 45 - 85 years, admitted in the 1st Department of Cardiology, between January June 2012, diagnosed with acute coronary syndromes (especially unstable angina). All the patients received Clopidogrel as antiplatelet agent, in some cases associated with aspirin. The diagnosis of acute coronary syndrome was based on clinical, ECG, echocardiographic and enzymatic signs. All the patients accepted to be included in the present study and signed a consent formulary. The Clopidogrel resistance was determined by specific genetic laboratory tests.
Results And Discussion:
Of 80 cases, 4 patients were identified as normal responders (5%), 3 patients were low responders (3.75%), 58 patients were high responders (72.5%) and 15 patients were unpredictable (18.75%). In the high responders' group a lot of hemorrhagic disorders in different territories were identified. Normal responders had a good evolution. In patients with low response and unpredictable status the recurrence of angina and left ventricular failure as complications were frequent.
Conclusions:
The present study allowed a positive correlation between the haemorrhagic events and the high responder status to Clopidogrel. Low responder patients or those with an unpredictable phenotype had a worse evolution caused by the recurrence of angina or left ventricular failure.
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