Evaluation of clopidogrel responsiveness after drug-eluting stent implantation.
Clopidogrel is a cornerstone of medical therapy in patients with cardiovascular disease, reducing the rate of ischemic events in patients with acute coronary syndrome, ST elevation myocardial infarction, and those undergoing percutaneous coronary intervention (PCI). Prolonged dual antiplatelet therapy with aspirin and a thienopyridine is mandated after drug-eluting stent implantation. However, there is substantial variability in the pharmacokinetics and pharmacodynamics of clopidogrel among individuals, and a lack of effect has been associated with adverse outcome after PCI, including drug-eluting stent thrombosis. The development of platelet function assays that can be performed in the clinical laboratory or at the point-of-care has made it possible to integrate the evaluation of clopidogrel response into clinical practice. Clinical utilization of platelet function testing requires an understanding of the types of methodologies that are available, the interpretation of the results that are provided, and the different potential treatment options in patients who are identified to be at risk. Several ongoing randomized clinical trials are testing the safety and efficacy of individualized antiplatelet therapy based on platelet function testing to reduce ischemic events after PCI with drug-eluting stents.
Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA 92037, USA. price.matthew@scrippshealth.org
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D001792:Blood Platelets / Q000187:drug effects; D000077144:Clopidogrel; D054855:Drug-Eluting Stents; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine