Incidence and Clinical Impact of Dual Nonresponsiveness to Aspirin and Clopidogrel in Patients With Drug-Eluting Stents

Anna Maria Gori, Rossella Marcucci, Angela Migliorini, Renato Valenti, Guia Moschi, Rita Paniccia, Piergiovanni Buonamici, Gian Franco Gensini, Ruben Vergara, Rosanna Abbate, David Antoniucci

Research output: Contribution to journalArticle

Abstract

Objectives: This study sought to determine the incidence of aspirin nonresponsiveness in addition to clopidogrel nonresponsiveness and whether this association identifies patients at an increased risk of drug-eluting stent (DES) thrombosis. Background: Nonresponsiveness to clopidogrel is a predictor of DES thrombosis. No prospective data exist about the possible association of dual nonresponsiveness to clopidogrel and aspirin with DES thrombosis. Methods: Platelet function was assessed after a loading dose of 600 mg clopidogrel in 746 patients who had successful DES implantation followed by 6-month dual-antiplatelet therapy. Platelet reactivity was assessed by light transmittance aggregometry using adenosine 5′-diphosphate, arachidonic acid, and collagen. The primary end point was definite/probable DES thrombosis at 6 months. The secondary end point was the composite of cardiac mortality and DES thrombosis. Results: The incidence of dual nonresponsiveness to aspirin and clopidogrel was 6%. Definite/probable DES thrombosis was significantly higher in dual aspirin and clopidogrel nonresponders (11.1%) than in clopidogrel and aspirin responders (2.1%, p <0.001), isolated clopidogrel nonresponders (2.2%, p <0.05), or aspirin nonresponders (2.3%, p <0.05). The incidence of the secondary end point was 4.4% in isolated clopidogrel nonresponders, 2.3% in isolated aspirin nonresponders, and 13.3% in dual aspirin and clopidogrel nonresponders. Dual clopidogrel and aspirin nonresponsiveness was an independent predictor of DES thrombosis (hazard ratio: 3.18, 95% confidence interval: 1.14 to 8.83, p = 0.027) and the composite of cardiac mortality and DES thrombosis (hazard ratio: 2.94, 95% confidence interval: 1.16 to 7.41, p = 0.022). Conclusions: Dual nonresponsiveness to aspirin and clopidogrel is a relatively infrequent condition that identifies patients at a very high risk of DES thrombosis or death.

Original languageEnglish
Pages (from-to)734-739
Number of pages6
JournalJournal of the American College of Cardiology
Volume52
Issue number9
DOIs
Publication statusPublished - Aug 26 2008

Keywords

  • clopidogrel
  • drug-eluting stent
  • nonresponsiveness
  • stent thrombosis

ASJC Scopus subject areas

  • Nursing(all)

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    Gori, A. M., Marcucci, R., Migliorini, A., Valenti, R., Moschi, G., Paniccia, R., Buonamici, P., Gensini, G. F., Vergara, R., Abbate, R., & Antoniucci, D. (2008). Incidence and Clinical Impact of Dual Nonresponsiveness to Aspirin and Clopidogrel in Patients With Drug-Eluting Stents. Journal of the American College of Cardiology, 52(9), 734-739. https://doi.org/10.1016/j.jacc.2008.05.032