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Impact of initial clinical presentation on clopidogrel low response

Jean-Baptiste Landel1, Anne Bauters, Cédric Delhaye

  • 1Unité des soins intensifs de cardiologie, centre hémodynamique, clinique de cardiologie, hôpital cardiologique, centre hospitalier régional et universitaire de Lille, boulevard du Pr-Jules-Leclercq, 59037 Lille cedex, France.

Archives of Cardiovascular Diseases
|September 28, 2013
PubMed

Insights

Acute coronary syndromes (ACS) significantly increase clopidogrel low response compared to stable coronary artery disease. This highlights the impact of initial clinical presentation on antiplatelet therapy effectiveness.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Clopidogrel response exhibits significant interindividual variability.
  • Low clopidogrel response is linked to adverse outcomes post-percutaneous coronary intervention.
  • Variability in clopidogrel response may also occur within individuals over time.

Purpose of the Study:

  • To evaluate how initial clinical presentation affects clopidogrel low response.
  • To compare clopidogrel response in patients with acute coronary syndromes versus stable coronary artery disease.

Main Methods:

  • Prospective study of 100 patients, divided into acute coronary syndromes (ACS) and stable coronary artery disease groups.
  • Clopidogrel response assessed 18-24 hours post-loading dose using VerifyNow-P2Y12 (platelet reaction units [PRUs]).
  • Exclusion criteria included chronic clopidogrel therapy or use of specific other antiplatelet/anticoagulant agents.

Main Results:

  • The ACS group showed significantly higher mean PRU values (197 ± 81) compared to the stable group (159 ± 94; p=0.03).
  • Multivariable analysis identified the ACS presentation as a significant predictor of higher PRU values (p=0.02).
  • Clopidogrel low responders (PRU > 230) were more frequent in the ACS group (38%) than in the stable group (18%; p=0.04).

Conclusions:

  • Initial clinical presentation, particularly acute coronary syndromes (ACS), is a strong predictor of clopidogrel low response.
  • Patient's evolving coronary artery disease influences clopidogrel response over time.
  • Findings support more aggressive antiplatelet strategies for ACS patients, aligning with recent trial outcomes.
Abstract

Keywords:
ACSADPAcute coronary syndromesAngioplastie coronaire percutanéeAntiagrégant plaquettaireAntiplatelet therapyBMIClopidogrel responsePCIPRUPercutaneous coronary interventionRéponse au clopidogrelSyndrome coronaire aiguVerifyNow-P2Y12acute coronary syndromesadenosine diphosphatebody mass indexpercutaneous coronary interventionplatelet reaction unit

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