Abstract
Background A double maintenance dose of clopidogrel at 150 mg daily has been suggested as an effective alternative treatment for patients who have clopidogrel resistance. Objective To determine if a double maintenance dose of clopidogrel can overcome the low drug response rate observed in patients who have clopidogrel resistance while on a 75 mg daily standard maintenance dose of clopidogrel. Methods A retrospective analysis was conducted in South Korean patients who underwent a platelet function test and received a double maintenance dose of clopidogrel at a secondary medical institution between January 2011 and June 2012. The primary endpoint was to assess clopidogrel response using an adenosine diphosphate test after a double maintenance dose of clopidogrel. The secondary endpoint was the presence of factors that could affect response to clopidogrel. Results Of 389 patients identified, 77 patients were eligible for this study. Values from the adenosine diphosphate test decreased significantly in 63 patients (82 %) after a double maintenance dose of clopidogrel (p < 0.001). A total of 37 patients (48 %) overcame clopidogrel resistance. Concurrent disease appeared to be a contributory factor in clopidogrel resistance. Conclusion A double maintenance dose of clopidogrel at 150 mg daily was associated with a reduction in adenosine diphosphate-induced platelet aggregation in South Korean patients who previously exhibited clopidogrel resistance.
References
Herbert JM, Savi P. P2Y12, a new platelet ADP receptor, target of clopidogrel. Semin Vasc Med. 2003;3:113–22.
O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, Lemos JA, et al. ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362–425.
Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, Alfonso F, Macaya C, Bass TA, et al. Variability in individual responsiveness to clopidogrel: clinical implications, management, and future perspectives. J Am Coll Cardiol. 2007;49:1505–16.
De Miguel A, Ibanez B, Badimon JJ. Clinical implications of clopidogrel resistance. Thromb Haemost. 2008;100:196–203.
Sofi F, Marcucci R, Gori AM, Giusti B, Abbate R, Gensini GF. Clopidogrel non-responsiveness and risk of cardiovascular morbidity: an updated meta-analysis. Thromb Haemost. 2010;103:841–8.
Tavassoli N, Voisin S, Carrie D, Lapeyre MM, Galinier M, Montastruc JL. High maintenance dosage of clopidogrel is associated with a reduced risk of stent thrombosis in clopidogrel-resistant patients. Am J Cardiovasc Drugs. 2010;10:29–35.
Price MJ, Berger PB, Teirstein PS, Tanguay JF, Angiolillo DJ, Spriggs D. Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial. JAMA. 2011;305:1097–105.
Gurbel PA, Becker RC, Mann KG, Steinhubl SR, Michelson AD. Platelet function monitoring in patients with coronary artery disease. J Am Coll Cardiol. 2007;50:1822–34.
Mehta SR, Tanguay JF, Eikelboom JW, Jolly SS, Joyner CD, Granger CB, et al. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet. 2010;376:1233–43.
Wilffert B, Swen J, Mulder H, Touw D, Maitland-Vander Zee AH, Deneer V. From evidence based medicine to mechanism based medicine. Reviewing the role of pharmacogenetics. Int J Clin Pharm. 2011;33(1):3–9.
Acknowledgments
The authors would like to thank director Kyung-lae Jung in division of pharmacy and medical teams from the Sun Medical Center, Daejeon for providing feedback on the manuscript.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Conflicts of interest
The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Author information
Authors and Affiliations
Corresponding author
Additional information
Ho Choi and JiHyeon Ryu have contributed equally to this work.
Rights and permissions
About this article
Cite this article
Choi, H., Ryu, J., Seo, H. et al. Is a high maintenance dose of clopidogrel suitable for overcoming clopidogrel resistance in patients?. Int J Clin Pharm 37, 758–761 (2015). https://doi.org/10.1007/s11096-015-0118-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-015-0118-z