Key result
Among 219 post-PCI patients, 46.12% exhibited aspirin resistance, 71.69% clopidogrel resistance, and 44.75% dual resistance, with CYP2C19 variants and platelet counts identified as key risk factors.
Why the study?
Because aspirin and clopidogrel are conventionally used after PCI for acute myocardial infarction, it is important to explore potential risk factors for resistance to these drugs.
What are the risk factors for aspirin and clopidogrel resistance in patients receiving dual antiplatelet therapy after PCI?
Observational (n=219)
What are the risk factors for aspirin and clopidogrel resistance in patients receiving dual antiplatelet therapy after PCI?
High rates of aspirin and clopidogrel resistance were observed in post-PCI patients, with specific genetic and hematologic factors predicting resistance.
High resistance rates post-PCI urge caution with standard DAPT; leaves open validation of CYP2C19 and platelet count as predictors.
Since aspirin and clopidogrel are the widely and conventionally used drugs to treat acute myocardial infarction after percutaneous coronary intervention (PCI), it is important to explore potential risk factors of their resistance. The platelet aggregation rate with arachidonic acid (AA, PAg-AA%) and adenosine diphosphate (ADP, PAg-ADP%) of 219 PCI patients were measured after standard treatment for 24 h. The disease history and laboratory data (before PCI) were obtained. We found 101 (46.12%) patients to be aspirin-resistant, and PAg-ADP% was the most prominent risk factor of aspirin resistance. Clopidogrel resistance was present in 157 of 219 patients. Patients in the clopidogrel-resistant group carried more CYP2C19*3 or *2, which was associated with higher clopidogrel resistance in this group (69.11%, 47/68) than in the control group (64.29%, 36/56). Platelet count (10 9 /L) and hemoglobin (g/L) were the prominent risk factors of clopidogrel resistance. Among the 219 patients, 98 showed dual antiplatelet drug resistance, for which platelet count (10 9 /L) and monocyte count (g/L) were the risk factors. Aspirin resistance was found to usually accompany clopidogrel resistance.
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Zhang et al. (2022) conducted an observational in Acute myocardial infarction after PCI (n=219). Clinical and genetic risk factors (CYP2C19 variants, platelet count, hemoglobin) vs. Patients without these risk factors was evaluated on Aspirin, clopidogrel, and dual antiplatelet drug resistance. Among 219 post-PCI patients, 46.12% exhibited aspirin resistance, 71.69% clopidogrel resistance, and 44.75% dual resistance, with CYP2C19 variants and platelet counts identified as key risk factors.
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