Prevalence,risk factors and management strategy of clopidogrel resistance in patients with coronary heart disease

Objective To observe the efficacy of clopidogrel for the prevalence and influential factors of clopidogrel resistance in patients with coronary heart disease,to explore the management strategy of clopidogrel resistance by measuring adenosine diphosphate(ADP)(10 and 20 μmol/L) induced platelet aggregation,and to know the expression of sCD40L and CD62P in plasma from coronary heart disease patients.Methods A total of 130 coronary heart disease patients were studied,their platelet aggregation,the expression of sCD40L and CD62P in plasma,before clopidogrel administration(baseline) and at 5 days after clopidogrel administration were measured.According to the value of platelet aggregation prior to and 5 days after clopidogrel administration,patients were divided into clopidogrel resistance group and non-clopidogrel resistance group.Platelet aggregation and the expression of sCD40L and CD62P in plasma of the nonresponders were tested at 5 days after drugs management.Results Among 130 patients,19(14.6%) patients were found clopidogrel resistance by measuring ADP(20 μmol/L) induced platelet aggregation,21(16.2%) nonresponders were found by measuring 10 μmol/L ADP induced platelet aggregation.In high dose group,platelet aggregation of the baseline was(10.9±3.6) Ω,platelet aggregation by management after 5 days was(8.1±3.1) Ω,which was significantly lower than the baseline level(P0.05).In maintenance dose group,platelet aggregation of the baseline was(9.9±5.1) Ω,platelet aggregation by management after 5 days was(7.4±5.7) Ω,which was not significantly lower than the baseline level(P0.05).Ten patients in high dose group reduced to 3 nonresponders(the prevalence of clopidogrel resistance was 30.0%),and 9 patients in maintenance dose group reduced to 5 nonresponders(the prevalence of clopidogrel resistance was 55.6%).Conclusion Clopidogrel-induced platelet inhibition is dose-and time-dependent.