Clopidogrel resistance: Implications for coronary stenting

Paul A. Gurbel, Wei C. Lau, Kevin P. Bliden, Udaya S. Tantry

Research output: Contribution to journalReview articlepeer-review

Abstract

Clopidogrel, in combination wih aspirin, is currently the drug of choice to prevent thrombosis after coronary stent implantation. Currently, clopidogrel is administered to the vast majority of patients without any assessment of platelet inhibition. Response variability and resistance, however, definitely occur to clopidogrel treatment. Preliminary data support the hypothesis that patients with reactive or clopidogrel nonresponsive platelets are at risk for thrombotic events. However, the magnitude of the clinical effect remains unknown and relationship between nonresponsiveness and risk of clinical events is under-investigated. Several important questions that must be answered are: A) What is the relation of clopidogrel resistance and high platelet reactivity to the occurrence of stent thrombosis, recurrent myocardial infarction, stroke and death?; B) Is there a threshold of platelet reactivity that correlates with the onset of thrombotic risk?; and C) What is the cost of administering clopidogrel to non-responsive patients? Finally, our understanding of the clinical relevance of drug resistance and high platelet reactivity should be facilitated by the use of validated point-of-service devices. The mechanisms of the response variability to clopidogrel remain incompletely defined. The contribution of intra- and extracellular pathways are under investigation.

Original languageEnglish (US)
Pages (from-to)1261-1269
Number of pages9
JournalCurrent pharmaceutical design
Volume12
Issue number10
DOIs
StatePublished - Apr 1 2006

Keywords

  • Cytochrome P450 (CYP)
  • Diacylglycerol
  • Platelet receptor
  • Polymorphisms
  • Prostaglandins
  • pravastatin

ASJC Scopus subject areas

  • Pharmacology
  • Drug Discovery

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