Effectiveness of reloading to overcome clopidogrel nonresponsiveness in patients with acute myocardial infarction

The American Journal of Cardiology
Shlomi MatetzkyHanoch Hod

Abstract

Whether increasing doses of clopidogrel can overcome nonresponsiveness was evaluated. Clopidogrel nonresponsiveness was found in up to 25% of treated patients and was associated with worse prognosis in patients with acute coronary syndrome and patients undergoing coronary intervention. Adenosine diphosphate (ADP)-induced platelet aggregation was prospectively determined on day 4 of acute myocardial infarction in 200 consecutive patients, who received clopidogrel 300 mg as a loading dose and 75 mg/day thereafter. Thirty patients (15%) had ADP-induced platelet aggregation >or=80% using light transmittance aggregometry and were considered clopidogrel nonresponders. Nonresponders were reloaded with clopidogrel 600 mg, followed by 150 mg/day for 4 weeks. A 75-mg/day dose was resumed thereafter. ADP-induced platelet aggregation was reassessed 4 hours after reloading and biweekly for 10 weeks. Flow cytometry was used to determine platelet P-selectin expression and fibrinogen binding before and 4 hours after reloading. ADP-induced platelet aggregation significantly decreased 4 hours after reloading (from 83 +/- 6% to 56 +/- 14%; p <0.01). The decrease in platelet aggregation was maintained throughout the 4-week doubled maintenance dose...Continue Reading

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Citations

Dec 17, 2009·Hematology·David Varon, Galia Spectre
Mar 17, 2010·Future Cardiology·Kathryn M Momary, Michael P Dorsch
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May 21, 2015·Biomedizinische Technik. Biomedical Engineering·Muhammad A Hasan, Derek Abbott
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Jun 2, 2009·Scandinavian Journal of Clinical and Laboratory Investigation·Øystein MeenGunnar Erikssen

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