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rdf:type |
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lifeskim:mentions |
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pubmed:issue |
2
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pubmed:dateCreated |
2008-2-18
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pubmed:abstractText |
The inhibitory platelet effect of clopidogrel is insufficient in approximately 5 to 30% of patients. These low responders (LR) face a significantly higher risk of cardiovascular complications. The therapeutic management of LR is still undefined. In the present study, we evaluate a novel therapeutic algorithm to reduce the incidence of clopidogrel resistance. One hundred sixty-one patients on 100 mg of aspirin co-medication underwent elective coronary stenting and were given an initial dosage of 600 mg clopidogrel, followed by 75 mg clopidogrel daily. 48 h later, the platelet responsiveness was tested with ADP (5-20 microM) stimulation by impedance aggregometry (Chronolog 590). A significant rise in impedance (>5 Omega after 6 minutes, aggregation index >65%) was defined as LR. In this subgroup, platelets were stimulated with the selective P2Y(12)-ADP receptor antagonist 2-MeS-AMP. One hundred twenty-three patients were clopidogrel-responders (76.4%) and 38 patients were LR (23.6%). A defect of the ADP-receptor P2Y(12) was found in three out of 38 LR (7.9%). Inhibition of platelet aggregation indicating clopidogrel-responsiveness was achieved with either a clopidogrel high-dose regimen (22/38, 57.9%); a repeat loading dose, doubling the maintenance dose) or with an alternative therapy with ticlopidine (8/38 (21.1%); 250 mg twice daily). Thus the incidence of LR was reduced from 23.6% to 5.0%. Our aggregometer-guided therapeutic algorithm reduced the relative percentage of clopidogrel LR by 78.9%. This approach could prove to be helpful in achieving a further decrease in the incidence of clopidogrel resistance.
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pubmed:language |
eng
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pubmed:journal |
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pubmed:citationSubset |
IM
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pubmed:chemical |
http://linkedlifedata.com/resource/pubmed/chemical/Adenosine Diphosphate,
http://linkedlifedata.com/resource/pubmed/chemical/Aspirin,
http://linkedlifedata.com/resource/pubmed/chemical/P2RY12 protein, human,
http://linkedlifedata.com/resource/pubmed/chemical/Platelet Aggregation Inhibitors,
http://linkedlifedata.com/resource/pubmed/chemical/Purinergic P2 Receptor Antagonists,
http://linkedlifedata.com/resource/pubmed/chemical/Receptors, Purinergic P2,
http://linkedlifedata.com/resource/pubmed/chemical/Receptors, Purinergic P2Y12,
http://linkedlifedata.com/resource/pubmed/chemical/Ticlopidine,
http://linkedlifedata.com/resource/pubmed/chemical/clopidogrel
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pubmed:status |
MEDLINE
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pubmed:month |
Feb
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pubmed:issn |
0340-6245
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pubmed:author |
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pubmed:issnType |
Print
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pubmed:volume |
99
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pubmed:owner |
NLM
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pubmed:authorsComplete |
Y
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pubmed:pagination |
357-62
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pubmed:dateRevised |
2010-11-18
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pubmed:meshHeading |
pubmed-meshheading:18278186-Adenosine Diphosphate,
pubmed-meshheading:18278186-Aged,
pubmed-meshheading:18278186-Algorithms,
pubmed-meshheading:18278186-Angioplasty, Balloon, Coronary,
pubmed-meshheading:18278186-Aspirin,
pubmed-meshheading:18278186-Blood Platelets,
pubmed-meshheading:18278186-Cardiovascular Diseases,
pubmed-meshheading:18278186-Clinical Protocols,
pubmed-meshheading:18278186-Coronary Artery Disease,
pubmed-meshheading:18278186-Dose-Response Relationship, Drug,
pubmed-meshheading:18278186-Drug Administration Schedule,
pubmed-meshheading:18278186-Drug Monitoring,
pubmed-meshheading:18278186-Drug Resistance,
pubmed-meshheading:18278186-Feasibility Studies,
pubmed-meshheading:18278186-Female,
pubmed-meshheading:18278186-Humans,
pubmed-meshheading:18278186-Male,
pubmed-meshheading:18278186-Middle Aged,
pubmed-meshheading:18278186-Pilot Projects,
pubmed-meshheading:18278186-Platelet Aggregation,
pubmed-meshheading:18278186-Platelet Aggregation Inhibitors,
pubmed-meshheading:18278186-Platelet Function Tests,
pubmed-meshheading:18278186-Prospective Studies,
pubmed-meshheading:18278186-Purinergic P2 Receptor Antagonists,
pubmed-meshheading:18278186-Receptors, Purinergic P2,
pubmed-meshheading:18278186-Receptors, Purinergic P2Y12,
pubmed-meshheading:18278186-Stents,
pubmed-meshheading:18278186-Ticlopidine
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pubmed:year |
2008
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pubmed:articleTitle |
How to optimise clopidogrel therapy? Reducing the low-response incidence by aggregometry-guided therapy modification.
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pubmed:affiliation |
Clinic of Cardiology & Angiology, St. Josef-Hospital / BG Kliniken Bergmannsheil, University Hospitals, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany. horst.neubauer@rub.de
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pubmed:publicationType |
Journal Article
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