Clopidogrel is often used to keep coronary stents patent
Clopidogrel resistance can be up to 30% of African/Asian populations
Should we be doing more routine testing for the marker of resistance- CYP 19 in these populations? Otherwise we may be giving placebo to our stent patients...
See attached
JACC and Medscape
I recommend Medscape as an excellent resource for busy clinicians to keep up to date [no conflict of interest]
Clopidogrel resistance has been found in roughly 20% individuals. High risk cases of PCI should be recognised and those individuals should be subjected to genetic testing before prescribing clopidogrel. Anyway, we hardly prescribe clopidogrel to our ACS patients who recieve either Ticagrelor or Pradugrel instead. Clopidogrel is reserved for stable CAD patients who are anyway low risk individuals.
Generally, in my hospital in Las Vegas, plavix is used for post CABG surgery but for PCI we use Brillianta or Pradugrel. Prior to those meds, we would use plavix with the caution not to use any PPI when discharged. We had some re-occlusions but I do not think that I saw a higher incidence in the African American or Asian populations. It happened more because of non-compliance or PPI use. One of the reasons that Ticagrelor is popular is the manufacturer's discount with coupon. That also has reduced non-compliance problems by addressing the financial burden.
PCI for stable CAD still need to be treated
with Clopidogrel accepting the resistance issue. Since, the large trials do not exist for the usage of newer, potent antiplatelet therapy in stable CAD patients, we should stick to aspirin - Clopidogrel combination. By and large, we don’t face any major problem in terms of SAT.
Absolutely agree that treatment is required, however, Plavix is not being used as
much in my hospital at least. Brillinta is the favorite, then Effient.
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