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.