Biological efficacy of a 600 mg loading dose of clopidogrel in ST-elevation myocardial infarction

Laurent Bonello; Julie Berbis; Marc Laine; Sébastien Armero; Jacques Bessereau; Laurent Jacquin; Caroline Bonello; Elise Camillieri; Paul Barragan; Françoise Dignat-George; Franck Paganelli; Laurence Camoin-Jau

doi:10.1160/TH12-02-0125

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2012; 108(01): 101-106
DOI: 10.1160/TH12-02-0125

Platelets and Blood Cells

Schattauer GmbH

Biological efficacy of a 600 mg loading dose of clopidogrel in ST-elevation myocardial infarction

Laurent Bonello

¹Département de Cardiologie, Hôpital Universitaire Nord, Aix-Marseille University, Marseille, France

²INSERM UMRS 608, Faculté de Pharmacie, Marseille, France

,

Julie Berbis

³Faculté de Médecine, Aix-Marseille University, Marseille, France

⁴Research Unit EA 3279 and Department of Public Health, Marseille, France

,

Marc Laine

¹Département de Cardiologie, Hôpital Universitaire Nord, Aix-Marseille University, Marseille, France

,

Sébastien Armero

¹Département de Cardiologie, Hôpital Universitaire Nord, Aix-Marseille University, Marseille, France

,

Jacques Bessereau

⁵Pôle RUSH, Hôpital Timone, Marseille, France

,

Laurent Jacquin

⁵Pôle RUSH, Hôpital Timone, Marseille, France

,

Caroline Bonello

⁶Service de Santé Publique et Information Médicale, Hôpital Universitaire Nord, Faculté de Médecine, Marseille, France

,

Elise Camillieri

⁷Service de Cardiologie, Hôpital de Martigues, Martigues, France

,

Paul Barragan

⁸Service de Cardiologie, Clinique les Fleurs, Ollioules, France

,

Françoise Dignat-George

²INSERM UMRS 608, Faculté de Pharmacie, Marseille, France

⁹Laboratoire d’Hématologie, Hôpital de la Conception, Marseille, France

,

Franck Paganelli

¹Département de Cardiologie, Hôpital Universitaire Nord, Aix-Marseille University, Marseille, France

,

Laurence Camoin-Jau

⁹Laboratoire d’Hématologie, Hôpital de la Conception, Marseille, France

¹⁰URMITE UMR 6236, CNRS-IRD, Faculté de Médecine et de Pharmacie, Marseille, France

› Author Affiliations

Abstract

Summary

Optimal platelet reactivity (PR) inhibition is critical to prevent thrombotic events in primary percutaneous coronary intervention (PCI). We aimed to determine the relationship between high on-treatment platelet reactivity (HTPR) and ST-elevation myocardial infarction (STEMI) following a 600 mg loading dose (LD) of clopidogrel. We performed a prospective monocentre study enrolling patients on clopidogrel undergoing PCI. The VASP index was used to assess PR inhibition after clopidogrel LD. HTPR was defined according to the consensus as a VASP index ≥50%. The present study included 833 patients undergoing PCI. Most patients had PCI for an acute coronary syndrome (58.7%). The mean VASP index was 50 ± 23% with a large inter-individual variability (range: 1–94%). Patients with a VASP index ≥50% were significantly older (p= 0.03), with a higher body mass index (BMI) (p<0.001), more often diabetic (p=0.03), taking omeprazole (p=0.03), admitted for an acute coronary syndrome (ACS) and with a high fibrinogen level compared to good responders (VASP <50%). In multivariate analysis BMI, omeprazole use, ACS and high fibrinogen level (p<0.001) remained significantly associated with HTPR. Of importance, in this analysis STEMI was independently associated with HTPR when compared with the other forms of ACS (NSTEMI and unstable angina) with an odd ratio of 2.14 (95% CI: 1.3 –3.5; p=0.003). In conclusion, STEMI is associated with high on-treatment platelet reactivity following 600 mg of clopidogrel. The present results suggest that 600 mg of clopidogrel may not be able to achieve an optimal PR inhibition in STEMI patients undergoing PCI and more potent drugs may be preferred.

Keywords

VASP index - percutaneous coronary intervention - high on-treatment platelet reactivity - acute coronary syndrome

Full Text

References

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