The Retrospective Analysis of Clopidogrel Resistance Tests
Clopidogrel Resistance Tests
Abstract views: 82
/ 
PDF downloads: 30
DOI:
https://doi.org/10.5281/zenodo.17419812Keywords:
Platelet Aggregation, Thrombosis, Blood CoagulationAbstract
Background: Clopidogrel binds to P2Y12 and inhibits platelet aggregation. Clopidogrel resistance can be categorized into two main categories: laboratory clopidogrel resistance and clinical clopidogrel resistance. Laboratory clopidogrel resistance refers to the inadequate in vitro antiplatelet effects of clopidogrel. In the present study, we aimed to evaluate the clopidogrel resistance test results from the perspective of laboratory specialists.
Methods: All clopidogrel resistance test results from the Bilkent City Hospital laboratory information system, between February 1, 2019, and May 31, 2025, were collected. Clopidogrel resistance tests were performed using the adenosine diphosphate-induced platelet aggregation method using an aggreometer device (Stago Chrono-Log Model 700). Data were expressed as mean, minimum, and maximum levels, numerically and as percentages. The Chi-square test was performed a categorical data comparison between the created groups. IBM SPSS Statistics performed statistical analyses for Windows, Version 27.0 (IBM Corp., Armonk, NY, USA).
Results: A total of 285 clopidogrel resistance test results were included. Negative and positive clopidogrel test results were as follows: 95 (33.3 %) and 190 (66.7 %). The present study consisted of 98 (34.4 %) females, 187 (65.6 %) males’ clopidogrel resistance tests. There were 107 (37.5%) clopidogrel resistance test results in the under 65 years old group, while there were 178 (62.5%) in the 65 and older years group. The neurology clinic requested clopidogrel resistance tests mostly (N:72, 62.5 %). No statistical differences were found in gender among age intervals (p>0.05), in clopidogrel resistance tests among gender (p>0.05), and in clopidogrel resistance tests among age intervals (p>0.05).
Conclusion: The most appropriate laboratory test to assess clopidogrel resistance has not yet been determined. The present study, evaluated from a laboratory perspective, may be useful for future research; however, prospective studies combining laboratory and clinical findings may be more effective.
References
del Zoppo GJ. Virchow's triad: the vascular basis of cerebral injury. Rev Neurol Dis. 2008;5 Suppl 1(Suppl 1):S12-S21.
Federman DG, Moriarty JP, Kravetz JD, Kirsner RS. Thrombosis: new culprits in an old disorder. Panminerva Med. 2002;44(2):107-113.
Pleines I, Eckly A, Elvers M, et al. Multiple alterations of platelet functions dominated by increased secretion in mice lacking Cdc42 in platelets. Blood. 2010;115(16):3364-3373. doi:10.1182/blood-2009-09-242271
Davì G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med. 2007;357(24):2482-2494. doi:10.1056/NEJMra071014
Jennings LK. Mechanisms of platelet activation: need for new strategies to protect against platelet-mediated atherothrombosis. Thromb Haemost. 2009;102(2):248-257. doi:10.1160/TH09-03-0192
Zahno A, Bouitbir J, Maseneni S, Lindinger PW, Brecht K, Krähenbühl S. Hepatocellular toxicity of clopidogrel: mechanisms and risk factors. Free Radic Biol Med. 2013;65:208-216. doi:10.1016/j.freeradbiomed.2013.06.007
Pereillo JM, Maftouh M, Andrieu A, et al. Structure and stereochemistry of the active metabolite of clopidogrel. Drug Metab Dispos. 2002;30(11):1288-1295. doi:10.1124/dmd.30.11.1288
Bates ER, Lau WC, Angiolillo DJ. Clopidogrel-drug interactions. J Am Coll Cardiol. 2011;57(11):1251-1263. doi:10.1016/j.jacc.2010.11.024
Taubert D, Kastrati A, Harlfinger S, et al. Pharmacokinetics of clopidogrel after administration of a high loading dose. Thromb Haemost. 2004;92(2):311-316. doi:10.1160/TH04-02-0105
Savcic M, Hauert J, Bachmann F, Wyld PJ, Geudelin B, Cariou R. Clopidogrel loading dose regimens: kinetic profile of pharmacodynamic response in healthy subjects. Semin Thromb Hemost. 1999;25 Suppl 2:15-19.
Mazoyer E, Ripoll L, Boisseau MR, Drouet L. How does ticlopidine treatment lower plasma fibrinogen?. Thromb Res. 1994;75(3):361-370. doi:10.1016/0049-3848(94)90251-8
Hayakawa M, Kuzuya F. Effects of ticlopidine on erythrocyte aggregation in thrombotic disorders. Angiology. 1991;42(9):747-753. doi:10.1177/000331979104200909
Balamuthusamy S, Arora R. Hematologic adverse effects of clopidogrel. Am J Ther. 2007;14(1):106-112. doi:10.1097/01.mjt.0000212708.81034.22
Mehta SR, Yusuf S, Peters RJ, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001;358(9281):527-533. doi:10.1016/s0140-6736(01)05701-4
Gurbel PA, Tantry US. Clopidogrel resistance?. Thromb Res. 2007;120(3):311-321. doi:10.1016/j.thromres.2006.08.012
CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348(9038):1329-1339. doi:10.1016/s0140-6736(96)09457-3
Dupont AG, Gabriel DA, Cohen MG. Antiplatelet therapies and the role of antiplatelet resistance in acute coronary syndrome. Thromb Res. 2009;124(1):6-13. doi:10.1016/j.thromres.2009.01.014
Wang TH, Bhatt DL, Topol EJ. Aspirin and clopidogrel resistance: an emerging clinical entity. Eur Heart J. 2006;27(6):647-654. doi:10.1093/eurheartj/ehi684
Güray Y, Güray U, Korkmaz S. Klopidogrel direnci [Clopidogrel resistance]. Anadolu Kardiyol Derg. 2009;9(3):231-237.
Barutcuoglu B. Antitrombositik tedavi izleminde trombosit fonksiyon testleri [Monitoring anti-platelet therapy with platelet function testing]. Türk Klinik Biyokimya Dergisi / Turkish Journal of Clinical Biochemistry. 2016;14:144-156.
Ryu DS, Hong CK, Sim YS, Kim CH, Jung JY, Joo JY. Anti-platelet drug resistance in the prediction of thromboembolic complications after neurointervention. J Korean Neurosurg Soc. 2010;48(4):319-324. doi:10.3340/jkns.2010.48.4.319
Di Minno G. Aspirin resistance and platelet turnover: a 25-year old issue. Nutr Metab Cardiovasc Dis. 2011;21(8):542-545. doi:10.1016/j.numecd.2011.04.002
Nguyen TA, Diodati JG, Pharand C. Resistance to clopidogrel: a review of the evidence. J Am Coll Cardiol. 2005;45(8):1157-1164. doi:10.1016/j.jacc.2005.01.034
İyigündoğdu İ, Şahin B, Derle E, Can U. Karotid arter stentleme yapılan hastalarda klopidogrel direnci ve etkileyen faktörlerin değerlendirilmesi. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2024;57(2):59-63. doi:10.20492/aeahtd.1426008
Mazzaccaro D, Giannetta M, Ranucci M, et al. Clopidogrel Resistance and Ticagrelor Replacement in Dual Antiplatelet Therapy for Carotid Artery Stenting. Ann Vasc Surg. 2023;90:128-136. doi:10.1016/j.avsg.2022.09.063
Müller-Schunk S, Linn J, Peters N, et al. Monitoring of clopidogrel-related platelet inhibition: correlation of nonresponse with clinical outcome in supra-aortic stenting. AJNR Am J Neuroradiol. 2008;29(4):786-791. doi:10.3174/ajnr.A0917
Prabhakaran S, Wells KR, Lee VH, Flaherty CA, Lopes DK. Prevalence and risk factors for aspirin and clopidogrel resistance in cerebrovascular stenting. AJNR Am J Neuroradiol. 2008;29(2):281-285. doi:10.3174/ajnr.A0818
Kim H, Lee HK, Han K, Jeon HK. Prevalence and risk factors for aspirin and clopidogrel resistance in patients with coronary artery disease or ischemic cerebrovascular disease. Ann Clin Lab Sci. 2009;39(3):289-294.
Atasoy D, Dinç H, Oğuz Ş, Sönmez M. Prevalence of aspirin and clopidogrel resistance in neurovascular stenting: A single-center experience. Eur Res J. 2021;7(6):601-609. doi:10.18621/eurj.848440
Yılmaz Can F, Çetin BN. Karotis renkli Doppler ultrasonografide anlamlı darlığı olan hastaların asetilsalisilik asit ve klopidogrel direnç sonuçlarının değerlendirilmesi. Türk Beyin Damar Hastalıkları Dergisi. 2022;28(1):46-53. doi:10.5505/tbdhd.2022.57805
Michos ED, Ardehali R, Blumenthal RS, Lange RA, Ardehali H. Aspirin and clopidogrel resistance. Mayo Clin Proc. 2006;81(4):518-526. doi:10.4065/81.4.518
Michelson AD. Platelet function testing in cardiovascular diseases. Circulation. 2004;110(19):e489-e493. doi:10.1161/01.CIR.0000147228.29325.F9
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Gamze Gök, Turan Turhan
This work is licensed under a Creative Commons Attribution 4.0 International License.
The journal is licensed under a 