Variability in Individual Responsiveness to Clopidogrel
Variability in Individual Responsiveness to Clopidogrel: Clinical Implications, Management, and Future Perspectives Dominick J. Angiolillo, Antonio Fernandez-Ortiz, Esther Bernardo, Fernando Alfonso, Carlos Macaya, Theodore A. Bass, Marco A. Costa Several studies have shown a broad variability in in...
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| Published in | Journal of the American College of Cardiology Vol. 49; no. 14; pp. 1505 - 1516 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Elsevier Inc
10.04.2007
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Variability in Individual Responsiveness to Clopidogrel: Clinical Implications, Management, and Future Perspectives
Dominick J. Angiolillo, Antonio Fernandez-Ortiz, Esther Bernardo, Fernando Alfonso, Carlos Macaya, Theodore A. Bass, Marco A. Costa
Several studies have shown a broad variability in individual responsiveness to clopidogrel. Notably, there is a growing degree of evidence that recurrence of ischemic complications may be attributed to poor response to this antiplatelet agent. This paper reviews the impact of individual response variability to clopidogrel on clinical outcomes and current and future directions for its management.
Antiplatelet therapy is the cornerstone of treatment for patients with acute coronary syndromes and/or undergoing percutaneous coronary interventions. Clopidogrel, in combination with aspirin, is currently the antiplatelet treatment of choice for prevention of stent thrombosis, and clinical trials have shown that, in high-risk patients, prolonged dual antiplatelet treatment is more effective than aspirin alone in preventing major cardiovascular events. However, despite the use of clopidogrel, a considerable number of patients continue to have cardiovascular events. Numerous in vitro studies have shown that individual responsiveness to clopidogrel is not uniform in all patients and is subject to inter- and intraindividual variability. Notably, there is a growing degree of evidence that recurrence of ischemic complications may be attributed to poor response to clopidogrel. The mechanisms leading to poor clopidogrel effects are not fully elucidated and are likely multifactorial. Although the gold standard definition to assess antiplatelet drug response has not been fully established, there is sufficient evidence to support that persistence of enhanced platelet reactivity despite the use of clopidogrel is a clinically relevant entity. This paper reviews the impact of individual response variability to clopidogrel on clinical outcomes and current and future directions for its management. |
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| AbstractList | Variability in Individual Responsiveness to Clopidogrel: Clinical Implications, Management, and Future Perspectives
Dominick J. Angiolillo, Antonio Fernandez-Ortiz, Esther Bernardo, Fernando Alfonso, Carlos Macaya, Theodore A. Bass, Marco A. Costa
Several studies have shown a broad variability in individual responsiveness to clopidogrel. Notably, there is a growing degree of evidence that recurrence of ischemic complications may be attributed to poor response to this antiplatelet agent. This paper reviews the impact of individual response variability to clopidogrel on clinical outcomes and current and future directions for its management.
Antiplatelet therapy is the cornerstone of treatment for patients with acute coronary syndromes and/or undergoing percutaneous coronary interventions. Clopidogrel, in combination with aspirin, is currently the antiplatelet treatment of choice for prevention of stent thrombosis, and clinical trials have shown that, in high-risk patients, prolonged dual antiplatelet treatment is more effective than aspirin alone in preventing major cardiovascular events. However, despite the use of clopidogrel, a considerable number of patients continue to have cardiovascular events. Numerous in vitro studies have shown that individual responsiveness to clopidogrel is not uniform in all patients and is subject to inter- and intraindividual variability. Notably, there is a growing degree of evidence that recurrence of ischemic complications may be attributed to poor response to clopidogrel. The mechanisms leading to poor clopidogrel effects are not fully elucidated and are likely multifactorial. Although the gold standard definition to assess antiplatelet drug response has not been fully established, there is sufficient evidence to support that persistence of enhanced platelet reactivity despite the use of clopidogrel is a clinically relevant entity. This paper reviews the impact of individual response variability to clopidogrel on clinical outcomes and current and future directions for its management. Variability in Individual Responsiveness to Clopidogrel: Clinical Implications, Management, and Future Perspectives Dominick J. Angiolillo, Antonio Fernandez-Ortiz, Esther Bernardo, Fernando Alfonso, Carlos Macaya, Theodore A. Bass, Marco A. Costa Several studies have shown a broad variability in individual responsiveness to clopidogrel. Notably, there is a growing degree of evidence that recurrence of ischemic complications may be attributed to poor response to this antiplatelet agent. This paper reviews the impact of individual response variability to clopidogrel on clinical outcomes and current and future directions for its management. |
| Author | Angiolillo, Dominick J. Fernandez-Ortiz, Antonio Alfonso, Fernando Bass, Theodore A. Costa, Marco A. Bernardo, Esther Macaya, Carlos |
| Author_xml | – sequence: 1 givenname: Dominick J. surname: Angiolillo fullname: Angiolillo, Dominick J. email: dominick.angiolillo@jax.ufl.edu organization: Division of Cardiology, University of Florida-Shands Jacksonville, Jacksonville, Florida – sequence: 2 givenname: Antonio surname: Fernandez-Ortiz fullname: Fernandez-Ortiz, Antonio organization: Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain – sequence: 3 givenname: Esther surname: Bernardo fullname: Bernardo, Esther organization: Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain – sequence: 4 givenname: Fernando surname: Alfonso fullname: Alfonso, Fernando organization: Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain – sequence: 5 givenname: Carlos surname: Macaya fullname: Macaya, Carlos organization: Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain – sequence: 6 givenname: Theodore A. surname: Bass fullname: Bass, Theodore A. organization: Division of Cardiology, University of Florida-Shands Jacksonville, Jacksonville, Florida – sequence: 7 givenname: Marco A. surname: Costa fullname: Costa, Marco A. organization: Division of Cardiology, University of Florida-Shands Jacksonville, Jacksonville, Florida |
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| Keywords | GTP NSTE-ACS PGE1 GP cAMP ADP VASP-P ACS MFI PCI LTA STEMI CYP ATP percutaneous coronary intervention acute coronary syndrome adenosine diphosphate non–ST-segment elevation acute coronary syndrome prostaglandin E 1 guanosine triphosphate cytochrome P450 light transmittance aggregometry vasodilator-stimulated phosphoprotein-phosphorylation median fluorescence intensity cyclic adenosine monophosphate adenosine triphosphate PGE 1 glycoprotein ST-segment elevation myocardial infarction |
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