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Subacute stent thrombosis in a patient with type 2 diabetes and clopidogrel resistance: A case report


Mei Chen Zhou, Shi Ping Cao, Hong Lan Zhong

    International Journal of Clinical Pharmacology and Therapeutics
    |May 1, 2020
    PubMed

    Insights

    Clopidogrel resistance, linked to CYP2C19*2 genetic variations and diabetes, increases stent thrombosis risk. Genetic testing can identify high-risk patients needing alternative antiplatelet strategies.

    Area of Science:

    • Cardiology
    • Pharmacogenomics
    • Clinical Medicine

    Background:

    • Clopidogrel is a primary oral antiplatelet agent for preventing recurrent ischemic events post-acute coronary syndromes or stent placement.
    • Stent thrombosis is a serious complication often linked to clopidogrel resistance.
    • The CYP2C19*2 allele is a known factor influencing clopidogrel metabolism and efficacy.

    Observation:

    • A 56-year-old male with type 2 diabetes experienced subacute stent thrombosis 8 days after percutaneous coronary intervention (PCI) with drug-eluting stents.
    • The patient was found to carry the CYP2C19*2 reduced-function allele.
    • Initial treatment involved aspirin and ticagrelor, followed by clopidogrel maintenance therapy.

    Findings:

    • The patient's stent thrombosis was associated with carriage of the CYP2C19*2 allele and type 2 diabetes.
    • These factors likely contributed to a reduced response to standard-dose clopidogrel.
    • Successful management involved tirofiban and balloon angioplasty.

    Implications:

    • Diabetes mellitus and CYP2C19*2 allele carriage are associated with reduced clopidogrel response and increased stent thrombosis risk.
    • CYP2C19 genetic testing can aid in identifying patients at higher risk.
    • Personalized antiplatelet therapy is crucial for high-risk patient populations.
    Abstract

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