The Study Of Influencing Factors And Prognosis Of Low Clopidogrel Responsiveness

Backward:With the increased incidence of coronary heart disease, percutaneous coronary intervention (PCI) have been applied more widely in clinical, thrombotic events related to operation is also more and more concern. Platelets play an important role in the pathogenesis of thrombotic events. Antiplatelet therapy is the basic treatment of patients after PCI. Clopidogrel is a thienopyridine antiplatelet agent, and play the antiplatelet effect by irreversible inhibition of platelet ADP receptor. But research has shown that platelet function inhibition by clopidogrel differs from clopidogrel differs individual to individual. Low clopidogrel responsiveness is associated with major adverse cardiovascular events after PCI, such as stent myocardial infarction, stent thrombosis and death. So studying the clinical factors of affecting clopidogrel response, and control of these factors, thus, it will to be important to the effectiveness of clopidogrel. The factors affecting the low response to clopidogrel, reported in the literature are different, Gurbel pointed out that many factors, such as BMI, age, diabetes, renal inadequacy and the interactions between drugs influence the reaction of clopidogrel. Tantry pointed out that smoking, coronary artery disease and other factors are also involved in the low response to clopidogrel. The effect of a low response to clopidogrel factors and their relationship with cardiovascular events are few reports in china.Objective:To assess the Influencing factors of low clopidogrel responsiveness in patients with coronary heart disease, analysis the relationship between low clopidogrel responsiveness and recurrent cardiovascular events after PCI.Methods:A total of400cases of coronary heart disease were assigned to clopidogrel low responder (n=79) and responder group (n=321) according to the results of ADP(10umo1/L)-induced platelet aggregation. All patients were received clopidogrel conventional dose treatment for3days or more, or oral300mg loading dose of clopidogrel at least6hours. Possible risk factors of low clopidogrel responsiveness were analyzed by single factor analysis and multi-factor gradual Logistic regression analysis. All patients were followed up to nine month after PCI, the primary endpoint was perioperative myocardial infarction, stent thrombosis, acute myocardial infarction, cardiac death and stroke.Results:The incidence of low clopidogrel responsiveness was19.8%. Platelet aggregation rates were (49±9) and (18±11) respectively-in two groups (P<0.01). Multivariate logistic regression analysis found that low clopidogrel responsiveness was positively correlated to diabetes mellitus (OR1.954,95%CI1.036-3.683, P<0.05), hyperlipidemia (OR1.915,95%CI1.014-3.617, P<0.05) and plasma fibrinogen (OR1.431,95%CI1.089-1.882, P<0.05). There are sixteen (20%) patients in the low clopidogrel responsiveness group and thirty-seven (12%) patients in the control group occurred cardiovascular events.Conclusions:Diabetes mellitus, hyperlipidemia, plasma fibrinogen and the history of prior PCI are the influence factors of low clopidogrel responsiveness. Low clopidogrel responsiveness group can increase the incidence of recurrent cardiovascular events.