Two studies concluded that clopidogrel resistance was a risk factor for thromboembolic complications, the other found higher values of P2Y12 reaction units in
, drug interactions involving
If clopidogrel resistance was identified, an alternative antiplatelet agent (ticlopidine, prasugrel or ticagrelor) was employed
Our case suggests that vorapaxar is a promising alternative for patients with ticagrelor resistance in flow diversion–treated intracranial aneurysms
The rate of antiplatelet resistance in patients with stroke or transient ischemic attack (TIA) is highly variable, ranging from 3 to
9
The concept of clopidogrel resistance has emerged as a possible explanation for the continued occurrence of ischemic events despite the adequate dosage of the antiplatelet agent and proper compliance
1,2 It is a prodrug that requires CYP2C19, a cytochrome P450 enzyme, for transformation to its active thiol metabolite
Clopidogrel resistance is best demonstrated by the evidence of residual post treatment P2Y12 activity by measuring ADP induced platelet aggregation before and after treatment
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Publication types Research Support
Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C1 9 Genotype and Clopidogrel Therapy: 2013 update (September 2013) 2013 supplement
This conversion is composed of two sequential oxidative steps, which involve cytochrome P450-2C19 One approach to managing clopidogrel resistance may involve giving higher loading and maintenance doses
These studies focused on extracranial cerebrovascular disease (n = 5) and peripheral arterial disease (PAD, n = 11), encompassing a total of 1,716 patients
The bottom line
AccuType® CP, Clopidogrel CYP2C19 Genotype - This pharmacogenetic test may be used to help guide clopidogrel prescribing, especially in patients with acute coronary syndrome (ACS) who have undergone percutaneous coronary intervention (PCI) [1]
The literature in fact there is a lack of recommendations about alternative therapies in clopidogrel nonresponders for patients who undergo CAS
Both medications are FDA-approved to reduce the rate of cardiovascular events in people with ACS
Clopidogrel is a prodrug, and CYP2C19 is the major enzyme involved in the conversion of clopidogrel into an active metabolite