Thromb Haemost 2011; 105(02): 211-220
DOI: 10.1160/TH10-08-0554
Review Article
Schattauer GmbH

Clopidogrel withdrawal: Is there a “rebound” phenomenon?

Nalyaka Sambu
1   Wessex Cardiothoracic Unit, Southampton University Hospital, UK
,
Timothy Warner
2   The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London UK
,
Nick Curzen
1   Wessex Cardiothoracic Unit, Southampton University Hospital, UK
3   Southampton University Medical School, UK
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received: 27. August 2010

Accepted after minor revision: 20. Oktober 2010

Publikationsdatum:
25. November 2017 (online)

Summary

Dual antiplatelet therapy with aspirin and clopidogrel is routinely indicated in patients with acute coronary syndromes and following percutaneous coronary intervention to reduce the risk of cardiovascular mortality and ischaemic events. Although clinical guidelines recommend aspirin lifelong and clopidogrel for between one and 12 months, depending upon the indication, the optimal duration of clopidogrel therapy actually remains contentious. Premature cessation of clopidogrel in patients receiving drug-eluting stents is a clear risk factor for stent thrombosis, but recent clinical studies have also demonstrated a link between “appropriate” cessation of clopidogrel and clustering of adverse clinical events. It has been suggested that this may be due to a “rebound” prothrombotic and/ or proinflammatory response associated with clopidogrel withdrawal. This review will examine the defini- tion and concept of a “rebound” phenomenon associated with clopidogrel cessation as well as the likely mechanisms behind this effect. Within the context of clinical event clustering after clopidogrel cessation, we will also discuss (i) the clinical importance of clopidogrel and the increasing uncertainty surrounding optimal duration of therapy, (ii) the antiplatelet and anti-inflammatory properties of clopidogrel and, in particular, its influence on arachidonic acid pathways traditionally thought to be mediated predominantly by aspirin and (iii) the role of newer, more potent antiplatelet agents and potential changes to anti-platelet therapy prescribing guidelines in the future.

 
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