Administration of Clopidogrel in patients after percutaneous coronary intervention / 中华老年医学杂志

ABSTRACT

Objective To provide supportive evidence for using Clopidogrel in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI). Methods From June 2015 to May 2016,105 cases of CHD were admitted to the Department of Cardiology,the First Affiliated Hospital of Zhengzhou University.Genetic testing for CYP2C19 polymorphisms combined with thromboela-stogram was used to detect the rate of Clopidogrel resistance,and adverse cardiovascular events were recorded for 12 months after PCI.Moreover,multivariate Logistic regression was used to analyze risk factors of Clopidogrel resistance. Results A total of 98 cases completed genetic testing for CYP2C19 polymorphisms.Cases with the wild type allele,heterozygous mutations and homozygous mutations accounted for 35.7%,57.1% and 7.1%,respectively.Compared that for wild type cases(49.6 ± 18.5)%,the platelet inhibition rate was significantly reduced for hybrid mutation cases(38.4 ± 15.2)% and homozygous mutation cases(24.8 ± 12.9)%(t=3.142,3.370;P=0.002,0.001,respectively).Meanwhile,based on pharmacokinetic characteristics,the rates of Clopidogrel resistance for patients with the intermediate metabolic type(the heterozygous mutant type) and the slow metabolic type(the homozygous mutant type)were significantly higher than that for patients with the normal metabolic type(the wild type)(χ2 = 5.687,6.363;P< 0.05,respectively). Follow-up results showed that the incidences of adverse cardiovascular events for wild-type and heterozygous mutation patients were 2.9% and 3.6%,respectively,which were significantly lower than that for homozygous mutant patients(28.6%)(χ2 = 5.815,6.540;P< 0.05,respectively). Multivariate Logistic regression analysis showed that risk factors for clopidogrel resistance were glycosylated hemoglobin Alc level,total cholesterol and white blood cell count. Conclusions Genetic testing for CYP2C19 polymorphisms combined with thromboela-stogram can be used as an effective way to evaluate whether Clopidogrel should be used.It is important to measure the platelet aggregation inhibition rate for early detection of Clopidogrel resistance to insure appropriate drug use.