Relationship between the responsive variability to clopidogrel in patients with acute coronary syndrome and the recurrent cardiovascular events
10.3760/cma.j.issn.1008-5734.2014.01.004
- VernacularTitle:急性冠状动脉综合征患者对氯吡格雷反应的变异性与再发心血管事件的关系
- Author:
Yamin LIU
1
;
Hua SHAO
;
Weilan LI
;
Hong ZHI
;
Can LUO
Author Information
1. 东南大学附属中大医院药剂科,南京,210009
- Publication Type:Journal Article
- Keywords:
Clopidogrel;
Acute coronary syndrome;
Recurrent cardiovascular events
- From:
Adverse Drug Reactions Journal
2014;16(1):10-14
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the relationship between the response variability in patients with acute coronary syndrome (ACS) treated with clopidogrel and the recurrent cardiovascular events.Methods The ACS patients received loading dose of clopidogrel (300 mg/d) on the first day of hospitalization or before percutaneous coronary intervention,then received maintenance dose of clopidogrel (75 mg/d) from the second day,in addition,all patients received aspirin (100 mg/d) for one year.The patients' maximal aggregation rate (MAR) and inhibition of platelet aggregation(IPA) were measured before and 24 hours after administration of loading dose of clopidogrel.The patients were divided into non-response to clopidogrel,low-response to clopidogrel,and response to clopidogrel groups according to the IPA.The patients were followed-up at the end of 1,3,6,and 12 months after administration,respectively.The situation of recurrent cardiovascular (CV) events including cardiovascular death,acute and subacute stent thromboses,recurrent acute coronary artery syndrome,and ischemic stroke were recorded.The differences in accumulative incidence of recurrent CV events among the 3 groups were compared by Kaplan-Meier survival analysis.Results A total of 190 patients with ACS who were hospitalized in the Department of Cardiology,Zhongda Hospital,Southeast University from October 2009 to March 2013 were enrolled into the study,comprising 111 males and 79 females with an average age of (66.1 ± 7.8) years.There were 53,46,and 91 patients in the non-response to clopidogrel group,the low-response to clopidogrel group,and the response to clopidogrel group,respectively.The differences in the sex composition,combined risk factors,and drug combination among the 3 groups were not significant (all P ＞ 0.05).The average age in the nonresponse to clopidogrel group [(69.1 ±7.8) years] was older than that in the response to clopidogrel group [(64.3 ± 7.4) years] (P ＜ 0.05).The accumulative incidence of recurrent CV events on 1,3,6,and 12months in the non-response to clopidogrel group [11.3％ (6/53) 、20.8％ (11/53) 、22.6％ (12/53) and35.8％ (19/53) were significantly higher than those in the response to clopidogrel group [1.1％ (1/91)、1.1％ (1/91) 、2.2％ (2/91) and 9.9％ (9/91)] (all P ＜ 0.05).The results of Kaplan-Meier survival analysis showed that the accumulative incidence of recurrent CV events in the non-response to clopidogrel group were significantly higher than those in the low-response to clopidogrel group (P ＜ 0.05) and the response to clopidogrel group (P ＜ 0.01).Conclusions The response variability to clopidogrel of patient with ACS may be associated with recurrent CV events.The patient who received clopidogrel should be given the examination of MAR and IPA in order to decrease or avoid the recurrent CV events.
