Clopidegrol Resistance in Patients Undergoing Percutaneous Coronary Intervention (PCI): our experiences at Apollo Hospitals Dhaka
Background: Dual antiplatelet (DAPT) treatment with Clopidegrol and Aspirin after percutaneous coronary intervention(PCI) is common practice for the interventionist to prevent thrombotic event after coronary stent placement. In spite of this, significant number of thrombotic events still occur. Exact data on our population regarding the thrombotic events after successful PCI and uses of DAPT not yet available. Therefore, we have carried out this study to see sensitivity resistance in our population by measuring Clopidegrol resistance test (CYP2C19 assay).
Methods: Total 351 patients were enrolled in this observation non randomized prospective cohort. Patient who had percutaneous coronary intervention (PCI) at our center or elsewhere, and on Clopidegrol with Aspirin, were selected for the study. Clopidegrol resistance were measured by PCR assay for CYP2C19 at our hospital molecular lab.
Results: Among the 351 patients, male 292 and female 59. Average age for the male: female was 59:61years. Clopidegrol resistant test was performed by Real Time PCR for CYP2C19. Total 57%(200) patients are Clopidegrol resistant or positive and 43%(151) patients are Negative. Among the resistant case 9.1%(32) patients are Homozygous Positive with probable genotype CYP2C19*2 (*2/*2) and 168 (47.8%) patients were Heterozygous positive with probable genotype CYP2C19(*1/*2). Among the CAD risk factors, Dyslipidemia were more, followed by HTN, DM, FH and smoking. Among the studied group; PCI territory Left Anterior Descending (LAD), total number of Percutaneous Coronary Intervention (PCI) and number of vessel that is Single Vessel Disease (SVD) were more in Heterozygous, Homozygous and CYP2C19 Negative group.
Conclusion: In this single center, observational prospective cohort, we found quiet a significant (57%) number of patients are Clopidegrol resistant. Therefore, we may need to double the Clopidegrol dose and or to start other antiplatelet such as Ticagrelor or prasugrel in addition to Aspirin. Thus, to prevent stent thrombosis or restenosis.
Cardiovasc. j. 2019; 12(1): 45-52