Poor response to clopidogrel is associated with adverse outcomes, and platelet function tests likely provide more clinically useful data than genetic tests for identifying this variability.
This review highlights that while clopidogrel resistance is linked to adverse outcomes in PCI patients, the optimal strategies for identifying and managing it using platelet function or genetic testing remain to be fully established.
Antiplatelet therapy with aspirin and clopidogrel in PCI patients, though effective, is still associated with thrombotic complications. These are multifactorial in origin, but partially attributable to "clopidogrel resistance." However, how best to identify and manage "clopidogrel resistance" remains unclear. Targeting therapeutic changes specifically at those individuals with poor response to clopidogrel is likely to be a solution. A "one size fits all" approach to clopidogrel dosing is probably flawed. This review will explore (1) the definition and mechanisms of clopidogrel resistance, (2) assessment of clopidogrel resistance by (i) platelet function testing and (ii) genetic testing, (3) the management of "clopidogrel resistance," and (4) newer antiplatelet agents, and evolving stent technology. A pubmed literature review was performed using the keywords "clopidogrel", "resistance", "poor response", "adverse events", "platelet function tests", and "genetic tests". In looking at new agents, keywords "prasugrel", "cangrelor", "ticagrelor""Elinogrel", and "P2Y12 receptor antagonists" were used. Third, a search was performed looking at "stent design", "IVUS", "bioabsorbable stents", and "stent apposition". Whilst new P2Y12 receptor antagonists and improved stent technology may reduce thrombotic events in the future, there is still a need for clopidogrel. There is good evidence that poor response to clopidogrel is associated with adverse outcome. Platelet function tests probably provide more clinically useful data than genetic tests, but the question of how best to identify and manage variability in response to clopidogrel demands further research.
Qureshi et al. (Wed,) conducted a review in Clopidogrel resistance in PCI patients. Clopidogrel was evaluated. Poor response to clopidogrel is associated with adverse outcomes, and platelet function tests likely provide more clinically useful data than genetic tests for identifying this variability.
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