Feher G, Feher A, Pusch G, Koltai K, Tibold A, Gasztonyi B, Papp E, Szapary L, Kesmarky G, Toth K. Clinical importance of aspirin and clopidogrel resistance. World J Cardiol 2010; 2(7): 171-186 [PMID: 21160749 DOI: 10.4330/wjc.v2.i7.171]
Corresponding Author of This Article
Gergely Feher, MD, PhD, Department of Neurology, University of Pecs, Ret utca 2, Pecs, Baranya, H-7623, Hungary. gergely.feher@aok.pte.hu
Article-Type of This Article
Editorial
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Four groups: group I received aspirin alone, group II aspirin and clopidogrel, group III aspirin and statin and group IV aspirin, clopidogrel and statin
6 mo mortality adjusted for baseline characteristics, in-hospital medications and procedures, re-hosp and revascularization
Combined ASA and clopidogrel resistance was more prevalent in patients with stent thrombosis (52%) compared with controls (38%, P = NS) and volunteers (11%, P < 0.05)
Previously 75 mg daily, 300-600 mg loading dose followed by 75 mg daily
325 mg
100
Cardiovascular event/revascularisation
Patients receiving chronic clopidogrel therapy who exhibit high on-treatment ADP-induced platelet aggregation are
at increased risk for postprocedural ischemic events
Whereas 40% of patients in the first quartile sustained a recurrent cardiovascular event, only 1 patient (6.7%) in the second quartile and none in the third and fourth quartiles suffered a cardiovascular event (P = 0.007)
Table 4 Clinical studies based on optical aggregometry combined with activation-dependent changes on the platelet surface or with vasodilator-stimulated phosphoprotein phosphorylation
Study
Method
Patient population
Dosage
Adjunct antiplatelet therapy
No. of patients (clopidogrel sensitive/clopidogrel resistant)
144 patients were divided into quintiles according to PRI
Cardiovascular events
Patients in quintile 1 of VASP analysis had a significantly lower risk of MACE as compared with those among the four higher quintiles (0 vs 21, P < 0.01)
392 (146 patients with 300 mg loading dose clopidogrel and 300 patients with 600 mg loading dose of clopidogrel)
Cardiovascular event
The ADP-induced platelet aggregation and expression of P-selectin were significantly lower in patients receiving 600 mg than in those receiving 300 mg. During the 1-mo follow-up, 18 CV events (12%) occurred in the 300-mg group vs 7 (5%) in the 600-mg group (P = 0.02); this difference was not affected by adjustment for conventional CV risk factors (P = 0.035)
Citation: Feher G, Feher A, Pusch G, Koltai K, Tibold A, Gasztonyi B, Papp E, Szapary L, Kesmarky G, Toth K. Clinical importance of aspirin and clopidogrel resistance. World J Cardiol 2010; 2(7): 171-186