Relationship between aspirin and clopidogrel responses in acute coronary syndrome and clinical predictors of non response.
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.
Cuisset
Thomas
T
Department of Cardiology, CHU Timone, Marseille, 13385 France. thomascuisset@voila.fr
Frere
Corinne
C
Quilici
Jacques
J
Morange
Pierre-Emmanuel
PE
Camoin
Laurence
L
Bali
Laurent
L
Lambert
Marc
M
Juhan-Vague
Irène
I
Alessi
Marie-Christine
MC
Bonnet
Jean-Louis
JL
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
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