title: Antiplatelet resistance and the role of associated variables in stable patients treated with stenting.
abstract: BACKGROUND
  Nowadays, clopidogrel and acetylsalicylic acid (ASA) have become routinely applied therapies in percutaneous coronary interventions (PCI) with stenting.
  
  
  OBJECTIVE
  Numerous variables can interfere with antiplatelet responsiveness, so we aimed to investigate the role of different variables associated with ASA or clopidogrel resistance in stable coronary artery disease.
  
  
  METHODS
  A total of 207 patients undergoing elective PCI were included in the analysis. All patients received a loading dose of clopidogrel and ASA during PCI procedure and followed by dual antiplatelet therapy. Clopidogrel and ASA resistance were measured by impedance aggregometry method.
  
  
  RESULTS
  Of the patients, 19.8% had clopidogrel resistance, 18.8% had ASA resistance, 9.2% had both clopidogrel and ASA resistance, and 71.5% were responsive to both drugs. In multivariate analysis, platelet count, angiotensin receptor blocker (ARB) use, and ASA resistance were independent variables associated with clopidogrel resistance, and clopidogrel resistance was the only variable associated with ASA resistance. In differentiating whether clopidogrel resistance exists or not, optimum ASA aggregometry response cut-off values were specified, and in differentiating whether ASA resistance exists or not, optimum clopidogrel aggregometry response cut-off values were specified.
  
  
  CONCLUSIONS
  In this study, there was a higher incidence of low responsiveness to ASA when there was a low response to clopidogrel, and vice versa. Angiotensin receptor blocker use, platelet count, and ASA resistance were independent variables associated with clopidogrel resistance. Clopidogrel resistance was the only independent variable associated with ASA resistance. Angiotensin receptor blocker use seems to an independent risk factor for clopidogrel resistance in this study, but this result needs to be verified in other studies.
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Uzun
authors.affiliation: Department of Cardiology, Usak State Hospital, Usak, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Biyik
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ibrahim Faruk
authors.initials: IF
authors.lastname: Akturk
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Erturk
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ahmet Arif
authors.initials: AA
authors.lastname: Yalcin
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Surgit
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ender
authors.initials: E
authors.lastname: Oner
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Hamdi
authors.initials: H
authors.lastname: Pusuroglu
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Birand
keywords: acetylsalicylic acid; angiotensin receptor blocker; clopidogrel; platelets; resistance
references.citation: J Am Coll Cardiol. 2003 Mar 19;41(6):961-5
references.pmid: 12651041
references.citation: Arq Bras Cardiol. 2012 Dec;99(6):1135-41
references.pmid: 23184076
references.citation: Clin Appl Thromb Hemost. 2015 Mar;21(2):166-71
references.pmid: 24057399
references.citation: J Thromb Thrombolysis. 2014 May;37(4):469-74
references.pmid: 23836454
references.citation: Thromb Haemost. 2003 May;89(5):783-7
references.pmid: 12719773
references.citation: Thromb Haemost. 2010 Jan;103(1):151-9
references.pmid: 20062919
references.citation: Anadolu Kardiyol Derg. 2013 Jun;13(4):370-3
references.pmid: 23591584
references.citation: Can J Cardiol. 1995 Mar;11(3):221-7
references.pmid: 7889440
references.citation: Circulation. 2006 Aug 22;114(8):838-54
references.pmid: 16923768
references.citation: Am J Cardiol. 2001 Aug 1;88(3):230-5
references.pmid: 11472699
references.citation: Circulation. 2002 Apr 9;105(14):1650-5
references.pmid: 11940542
references.citation: Angiology. 2012 Jan;63(1):62-6
references.pmid: 21602258
references.citation: Platelets. 2014;25(2):102-10
references.pmid: 23527528
references.citation: Circulation. 2011 Dec 6;124(23):e574-651
references.pmid: 22064601
references.citation: Eur J Intern Med. 2006 Aug;17(5):349-54
references.pmid: 16864011
references.citation: Circulation. 1997 Jan 7;95(1):125-32
references.pmid: 8994427
references.citation: J Cardiovasc Pharmacol. 2009 May;53(5):368-72
references.pmid: 19247187
references.citation: J Am Coll Cardiol. 2009 Mar 10;53(10):849-56
references.pmid: 19264241
references.citation: J Geriatr Cardiol. 2013 Mar;10(1):21-7
references.pmid: 23610570
references.citation: Acta Neurol Scand. 2013 Oct;128(4):213-9
references.pmid: 23432706
references.citation: Circulation. 2009 Jan 20;119(2):237-42
references.pmid: 19118249
references.citation: Circulation. 2003 Jun 17;107(23):2908-13
references.pmid: 12796140
references.citation: J Thromb Thrombolysis. 2012 May;33(4):349-54
references.pmid: 22189756
references.citation: J Am Coll Cardiol. 2006 Jan 3;47(1):27-33
references.pmid: 16386660
references.citation: Eur Heart J. 2004 Mar;25(6):476-83
references.pmid: 15039127
references.citation: Clin Appl Thromb Hemost. 2014 Oct;20(7):749-54
references.pmid: 23493759
references.citation: Eur Heart J. 2008 Apr;29(8):992-1000
references.pmid: 18263931
references.citation: Curr Opin Pharmacol. 2013 Apr;13(2):242-50
references.pmid: 23294895
references.citation: J Clin Pharm Ther. 2012 Dec;37(6):630-6
references.pmid: 23121257
references.citation: J Nephrol. 2011 Sep-Oct;24(5):636-46
references.pmid: 21279952
references.citation: Stroke Res Treat. 2013;2013:727842
references.pmid: 23936730
references.citation: Platelets. 2014;25(6):447-51
references.pmid: 24102371
references.citation: J Am Coll Cardiol. 2005 Jan 18;45(2):246-51
references.pmid: 15653023
references.citation: Nephrol Dial Transplant. 2012 Apr;27(4):1460-6
references.pmid: 21865214
references.citation: J Atheroscler Thromb. 2011;18(7):560-7
references.pmid: 21427509