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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
1   Département de Cardiologie, Hôpital Universitaire Nord, Aix-Marseille University, Marseille, France
2   INSERM UMRS 608, Faculté de Pharmacie, Marseille, France
,
Julie Berbis
3   Faculté de Médecine, Aix-Marseille University, Marseille, France
4   Research Unit EA 3279 and Department of Public Health, Marseille, France
,
Marc Laine
1   Département de Cardiologie, Hôpital Universitaire Nord, Aix-Marseille University, Marseille, France
,
Sébastien Armero
1   Département de Cardiologie, Hôpital Universitaire Nord, Aix-Marseille University, Marseille, France
,
Jacques Bessereau
5   Pôle RUSH, Hôpital Timone, Marseille, France
,
Laurent Jacquin
5   Pôle RUSH, Hôpital Timone, Marseille, France
,
Caroline Bonello
6   Service de Santé Publique et Information Médicale, Hôpital Universitaire Nord, Faculté de Médecine, Marseille, France
,
Elise Camillieri
7   Service de Cardiologie, Hôpital de Martigues, Martigues, France
,
Paul Barragan
8   Service de Cardiologie, Clinique les Fleurs, Ollioules, France
,
Françoise Dignat-George
2   INSERM UMRS 608, Faculté de Pharmacie, Marseille, France
9   Laboratoire d’Hématologie, Hôpital de la Conception, Marseille, France
,
Franck Paganelli
1   Département de Cardiologie, Hôpital Universitaire Nord, Aix-Marseille University, Marseille, France
,
Laurence Camoin-Jau
9   Laboratoire d’Hématologie, Hôpital de la Conception, Marseille, France
10   URMITE UMR 6236, CNRS-IRD, Faculté de Médecine et de Pharmacie, Marseille, France
› Author Affiliations Financial support: The study was supported by an institutional grant from the Assistance publique-Hopitaux de Marseille.
Further Information

Publication History

Received: 29 February 2012

Accepted after major revision: 29 March 2012

Publication Date:
22 November 2017 (online)

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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
 

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