May 20, 2026Journal of the American College of Cardiology
Platelet Reactivity After Clopidogrel Treatment Assessed With Point-of-Care Analysis and Early Drug-Eluting Stent Thrombosis
Key result
Low clopidogrel response linked to ~840% higher 30-day ST risk versus normal responders.
- OR 9.4
- 95% CI 3.1 to 28.4
- P<0.0001
- n=1,608
Why the study?
Light transmission aggregometry links poor clopidogrel response to adverse cardiovascular events after PCI but is labor-intensive and inconvenient for routine use, making a point-of-care assay desirable.
Does high platelet reactivity (low response) to clopidogrel assessed with point-of-care multiple electrode aggregometry predict early drug-eluting stent thrombosis in patients undergoing PCI?
Population
1,608 consecutive CAD patients with planned drug-eluting stent implantation
Comparison
Clopidogrel low responders vs normal responders by MEA
Design
Prospective trial
Follow-up
30 days
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
PGPaul GurbelDirector, Inova Heart and Vascular Institute
“We're still not measuring [platelet reactivity] in patients as a standard of care. We're not moving the needle.”
Implication
Low clopidogrel reactivity identifies higher early stent thrombosis risk after DES; leaves open whether monitoring or adjustment improves outcomes.
Key Points
- This trial aims to determine the correlation between platelet reactivity to clopidogrel and the risk of early drug-eluting stent thrombosis.
- Prospective trial with 1,608 patients undergoing drug-eluting stent implantation.
- Platelet aggregation assessed using multiple electrode platelet aggregometry before percutaneous coronary intervention.
- Primary endpoint measured was definite stent thrombosis at 30 days.
- Low responders (2.2%) had a significantly higher risk of definite stent thrombosis than normal responders (0.2%; OR: 9.4; 95% CI: 3.1 to 28.4; p < 0.0001).
- Mortality rates were higher in low responders (1.2%) versus normal responders (0.4%; OR: 3.2; 95% CI: 0.9 to 11.1; p = 0.07).
- Composite event of death or stent thrombosis was significantly higher in low responders (3.1%) compared to normal responders (0.6%; OR: 5.1; 95% CI: 2.2 to 11.6; p < 0.001).
Study Design
Type
Cohort (n=1,608)
Structured PICO
Does high platelet reactivity (low response) to clopidogrel assessed with point-of-care multiple electrode aggregometry predict early drug-eluting stent thrombosis in patients undergoing PCI?
P
Population
1,608 consecutive patients with coronary artery disease undergoing planned drug-eluting stent implantation, followed for 30 days.
E
Exposure
Clopidogrel low responders (upper quintile of platelet reactivity assessed with multiple electrode platelet aggregometry [MEA]) after receiving 600 mg clopidogrel before PCI.
C
Comparator
Clopidogrel normal responders (lower four quintiles of MEA measurements) after receiving 600 mg clopidogrel before PCI.
O
Outcome
Definite stent thrombosis (ST) at 30 days.hard clinical
Main Result
Odds Ratio: 9.4 (95% CI 3.1–28.4)
Absolute Event Rate: 2.2% vs 0.2%
p-value: p=< 0.0001
Point-of-care assessment of clopidogrel response using multiple electrode aggregometry can effectively identify patients at high risk for early drug-eluting stent thrombosis.
Cite This Study
Sibbing et al. (2009) conducted a cohort in coronary artery disease (n=1,608). Low response to clopidogrel vs. Normal response to clopidogrel was evaluated on definite ST at 30 days (OR 9.4, 95% CI 3.1 to 28.4, p=< 0.0001). Low response to clopidogrel assessed with MEA was associated with a higher risk of definite stent thrombosis at 30 days compared with normal response (2.2% vs 0.2%; OR 9.4; 95% CI 3.1-28.4; p<0.0001).