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Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity.

Publication ,  Journal Article
Gurbel, PA; Bliden, KP; Hiatt, BL; O'Connor, CM
Published in: Circulation
June 17, 2003

BACKGROUND: Clopidogrel is administered to prevent stent thrombosis; however, the uniformity of platelet inhibition after treatment and the influence of pretreatment reactivity on drug response have not been described. METHODS AND RESULTS: Platelet aggregation (5 and 20 micromol/L ADP), the activation of glycoprotein IIb/IIIa (PAC-1 antibody), and the expression of P-selectin were measured in patients undergoing elective coronary stenting (n=96) at baseline and at 2 hours, 24 hours, 5 days, and 30 days after stenting. All patients received aspirin (325 mg). Clopidogrel (300 mg) was administered in the catheterization laboratory and followed by 75 mg daily. There was marked interindividual variability in drug response as measured by all markers that showed a normal distribution. Resistance, defined as baseline aggregation (%) minus posttreatment aggregation (%) < or =10% by 5 micromol/L ADP, was present in 31% and 15% of patients at 5 and 30 days, respectively. Patients with the highest pretreatment platelet reactivity remained the most reactive at 24 hours after treatment (P<0.0001). CONCLUSIONS: Interindividual variability in the platelet inhibitory response from clopidogrel occurs in patients undergoing elective coronary stenting. Patients with high pretreatment reactivity are least protected. Alternative pharmacological strategies and the association of adverse ischemic events should be investigated in these patients.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

June 17, 2003

Volume

107

Issue

23

Start / End Page

2908 / 2913

Location

United States

Related Subject Headings

  • Ticlopidine
  • Stents
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Platelet Aggregation
  • P-Selectin
  • Male
  • Humans
  • Genetic Variation
  • Flow Cytometry
 

Citation

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Gurbel, P. A., Bliden, K. P., Hiatt, B. L., & O’Connor, C. M. (2003). Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation, 107(23), 2908–2913. https://doi.org/10.1161/01.CIR.0000072771.11429.83
Gurbel, Paul A., Kevin P. Bliden, Bonnie L. Hiatt, and Christopher M. O’Connor. “Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity.Circulation 107, no. 23 (June 17, 2003): 2908–13. https://doi.org/10.1161/01.CIR.0000072771.11429.83.
Gurbel PA, Bliden KP, Hiatt BL, O’Connor CM. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation. 2003 Jun 17;107(23):2908–13.
Gurbel, Paul A., et al. “Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity.Circulation, vol. 107, no. 23, June 2003, pp. 2908–13. Pubmed, doi:10.1161/01.CIR.0000072771.11429.83.
Gurbel PA, Bliden KP, Hiatt BL, O’Connor CM. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation. 2003 Jun 17;107(23):2908–2913.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

June 17, 2003

Volume

107

Issue

23

Start / End Page

2908 / 2913

Location

United States

Related Subject Headings

  • Ticlopidine
  • Stents
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Platelet Aggregation
  • P-Selectin
  • Male
  • Humans
  • Genetic Variation
  • Flow Cytometry