Clopidogrel High On-Treatment Platelet Reactivity in Patients with Carotid Artery Stenosis Undergoing Endarterectomy. A Pilot Study

Title:Clopidogrel High On-Treatment Platelet Reactivity in Patients with Carotid Artery Stenosis Undergoing Endarterectomy. A Pilot Study

Volume: 14 Issue: 6

Author(s): Dragana Backovic, Svetlana Ignjatovic, Ljiljana Rakicevic, Mirjana Novkovic, Jelena Kusic-Tisma, Dragica Radojkovic, Evgenija Strugarevic, Branko Calija, Djordje Radak and Mirjana Kovac

Affiliation:

Keywords: Carotid artery stenosis, carotid endarterectomy, clopidogrel, platelet reactivity, risk factors, CYP2C19*2.

Abstract: Objectives: A considerable number of patients do not achieve an adequate response to clopidogrel. Our study aimed to evaluate genetic and non-genetic factors as possible risks for clopidogrel high on-treatment platelet reactivity (HTPR) in patients (n=112) with carotid artery stenosis undergoing endarterectomy (CEA).

Methods: Using multiple-electrode impedance aggregometry (MEA) the antiplatelet effectiveness of clopidogrel was measured after 24 h, 7 and 30 days of clopidogrel treatment, which was introduced after elective CEA at a dose of 75 mg daily, for at least 30 days.

Results: HTPR was observed among 25% patients after clopidogrel therapy for 30 days. Further analysis showed that 53.3% of patients carrying the CYP2C19*2 gene variant had clopidogrel-HTPR, while in the wild type group there were 14.6% (p<0.001). Multivariate logistic regression analysis identified the CYP2C19*2 variant allele (OR 4.384; 95% CI 1.296-14.833, p=0.017) and high total cholesterol level (OR 2.090; 95% CI 1.263-3.459, p=0.004) as the only independent risk factors for clopidogrel-HTPR.

Conclusion: The CYP2C19*2 gene variant and high total cholesterol level were major factors for clopidogrel- HTPR in patients with carotid artery stenosis undergoing CEA.

Cite this article as:

Backovic Dragana, Ignjatovic Svetlana, Rakicevic Ljiljana, Novkovic Mirjana, Kusic-Tisma Jelena, Radojkovic Dragica, Strugarevic Evgenija, Calija Branko, Radak Djordje and Kovac Mirjana, Clopidogrel High On-Treatment Platelet Reactivity in Patients with Carotid Artery Stenosis Undergoing Endarterectomy. A Pilot Study, Current Vascular Pharmacology 2016; 14 (6) . https://dx.doi.org/10.2174/1570161114666160714103148