Document Detail

Clopidogrel resistance: role of body mass and concomitant medications.
MedLine Citation:
PMID:  17169448     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Platelets have a central role in the development of arterial thrombosis and subsequent cardiovascular events. An appreciation of this has made antiplatelet therapy the cornerstone of cardiovascular disease management. Recent studies have described the phenomenon of clopidogrel resistance but the possible mechanisms are still unclear. PATIENTS AND METHODS: The aim of this study was to compare the characteristics (risk profile, previous diseases, medications, hemorheological variables and plasma von Willebrand factor and soluble P-selectin levels) of patients in whom clopidogrel provided effective platelet inhibition with those in whom clopidogrel was not effective in providing platelet inhibition. 157 patients with chronic cardio- and cerebrovascular diseases (83 males, mean age 61+/-11 yrs, 74 females, 63+/-13 yrs) taking 75 mg clopidogrel daily (not combined with aspirin) were included in the study. RESULTS: Compared with clopidogrel-resistant patients (35 patients (22%), patients who demonstrated effective clopidogrel inhibition had a significantly lower BMI (26.1 vs. 28.8 kg/m2, p<0.05). Patients with ineffective platelet aggregation were significantly more likely to be taking benzodiazepines (25% vs. 10%) and selective serotonin reuptake inhibitors (28% vs. 12%) (p<0.05). After an adjustment to the risk factors and medications BMI (OR 2.62; 95% CI: 1.71 to 3.6; p<0.01), benzodiazepines (OR 5.83; 95% CI: 2.53 to 7.1; p<0.05) and SSRIs (OR 5.22; 95% CI: 2.46 to 6.83; p<0.05) remained independently associated with CLP resistance. There was no significant difference in the rheological parameters and in the plasma levels of adhesive molecules between the two examined groups. CONCLUSION: The background of ineffective clopidogrel medication is complex. Drug interactions may play a role on clopidogrel bioavailability, on the other hand, the significant difference in BMI between the two examined groups suggests that clopidogrel therapy should be weight-adjusted.
Gergely Feher; Katalin Koltai; Balint Alkonyi; Elod Papp; Zsuzsa Keszthelyi; Gabor Kesmarky; Kalman Toth
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Publication Detail:
Type:  Journal Article     Date:  2006-12-13
Journal Detail:
Title:  International journal of cardiology     Volume:  120     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-07-16     Completed Date:  2007-08-16     Revised Date:  2009-04-16    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  188-92     Citation Subset:  IM    
First Department of Medicine, University of Pecs, Medical School, Pecs, Hungary.
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MeSH Terms
Benzodiazepines / therapeutic use
Body Mass Index*
Drug Interactions
Drug Resistance*
Middle Aged
Platelet Aggregation Inhibitors / therapeutic use*
Risk Factors
Serotonin Uptake Inhibitors / therapeutic use
Thromboembolism / prevention & control*
Ticlopidine / analogs & derivatives*,  therapeutic use
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 0/Serotonin Uptake Inhibitors; 12794-10-4/Benzodiazepines; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel
Comment In:
Int J Cardiol. 2009 Jan 9;131(2):267-8; author reply 268-9   [PMID:  17692411 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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