title: Relationship between aspirin and clopidogrel responses in acute coronary syndrome and clinical predictors of non response.
abstract: OBJECTIVE
  We have prospectively investigated the association between aspirin and clopidogrel responses and the clinical predictors of non response.
  
  
  METHODS
  635 Non ST Elevation Acute Coronary Syndrome (NSTE ACS) patients were included and received loading doses of 250 mg aspirin and 600 mg clopidogrel. We analyzed post-treatment maximal intensity of arachidonic acid and ADP-induced platelet aggregation (AA-Ag and ADP-Ag) and Platelet Reactivity Index of VAsodilator-Stimulated Phosphoprotein (PRI VASP). Aspirin and clopidogrel non responses were defined respectively by AA-Ag>30% and ADP-Ag>70%.
  
  
  RESULTS
  Aspirin non responders patients had significantly higher ADP-Ag and PRI VASP than aspirin responders: 63.7+/-15.9% vs 55+/-19% (p=0.0001) and 73.6+/-13.3% vs 53+/-23% (p=0.0001) respectively and the rate of clopidogrel non responders was higher among aspirin non responders than aspirin responders: 36.7% vs 22.7% (p=0.003). In addition, clopidogrel non responders had significantly higher AA-Ag and rate of aspirin non responders than clopidogrel responders: 21.6+/-24% vs 10.3+/-19% (p=0.0001) and 22.8% vs 12.9% (p=0.003) respectively. Age and Body Mass Index (BMI) were significantly associated with non response to Clopidogrel (p=0.035 and 0.02 respectively) and diabetes mellitus by trend (p=0.07).
  
  
  CONCLUSIONS
  We observed a relationship between aspirin and clopidogrel non responses and an association between age, BMI and diabetes mellitus and clopidogrel response.
authors.affiliation: Department of Cardiology, CHU Timone, Marseille, 13385 France. thomascuisset@voila.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Cuisset
authors.forename: Corinne
authors.initials: C
authors.lastname: Frere
authors.forename: Jacques
authors.initials: J
authors.lastname: Quilici
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Morange
authors.forename: Laurence
authors.initials: L
authors.lastname: Camoin
authors.forename: Laurent
authors.initials: L
authors.lastname: Bali
authors.forename: Marc
authors.initials: M
authors.lastname: Lambert
authors.forename: Irène
authors.initials: I
authors.lastname: Juhan-Vague
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Alessi
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bonnet
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy*; D000367:Age Factors; D000368:Aged; D016718:Arachidonic Acid / Q000378:metabolism; D001241:Aspirin / Q000494:pharmacology* / Q000627:therapeutic use; D015992:Body Mass Index; D015815:Cell Adhesion Molecules / Q000378:metabolism; D000077144:Clopidogrel; D048909:Diabetes Complications / Q000097:blood / Q000188:drug therapy; D004351:Drug Resistance; D006801:Humans; D008297:Male; D008840:Microfilament Proteins / Q000378:metabolism; D008875:Middle Aged; D010750:Phosphoproteins / Q000378:metabolism; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000098662:Vasodilator-Stimulated Phosphoprotein
chemical_list: D015815:Cell Adhesion Molecules; D008840:Microfilament Proteins; D010750:Phosphoproteins; D010975:Platelet Aggregation Inhibitors; D000098662:Vasodilator-Stimulated Phosphoprotein; D016718:Arachidonic Acid; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin