Clopidogrel resistance: role of body mass and concomitant medications.
Clopidogrel resistance: role of body mass and concomitant medications.
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DOI：
10.1016/j.ijcard.2006.09.014
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发表时间：
2007-08
影响因子：
3.5
通讯作者：
G. Fehér;K. Koltai;B. Alkonyi;E. Papp;Z. Keszthelyi;G. Késmárky;K. Tóth
中科院分区：
文献类型：
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作者：
G. Fehér;K. Koltai;B. Alkonyi;E. Papp;Z. Keszthelyi;G. Késmárky;K. Tóth
引言血小板在动脉血栓形成和随后的心血管事件的发生中发挥着核心作用。对这一点的认识使抗血小板治疗成为心血管疾病管理的基石。最近的研究描述了氯吡格雷抵抗的现象，但可能的机制仍不清楚。（风险概况、既往疾病、药物、血液流变学变量和血浆血管性血友病因子和可溶性P-选择素水平）氯吡格雷提供有效血小板抑制的患者与氯吡格雷不能有效提供血小板抑制的患者。157例慢性心脑血管疾病患者（83例男性，平均年龄61±11岁，74例女性，63±13岁），每日服用75 mg氯吡格雷与氯吡格雷耐药患者相比，（35例患者（22%），显示有效氯吡格雷抑制的患者具有显著较低的BMI（26.1 vs. 28.8 kg/m2，p<0.05）。血小板聚集无效的患者更可能服用苯二氮卓类药物（25%对10%）和选择性5-羟色胺再摄取抑制剂（28%对12%）（p<0.05）。在调整风险因素和药物BMI（OR 2.62; 95% CI：1.71至3.6; p<0.01）后，苯二氮卓类（OR 5.83; 95% CI：2.53至7.1; p<0.05）和SSRI（OR 5.22; 95% CI：2.46至6.83; p<0.05）仍然与CLP抵抗独立相关。有没有显着差异的流变学参数和粘附分子的血浆水平之间的两个examinedgroup. CONCLUSION无效的氯吡格雷药物治疗的背景是复杂的。药物相互作用可能对氯吡格雷的生物利用度起作用，另一方面，两个检查组之间BMI的显著差异表明氯吡格雷治疗应根据体重调整。
INTRODUCTIONPlatelets have a central role in the development of arterial thrombosis and subsequent cardiovascular events. An appreciation of this has made antiplatelet therapy the cornerstone of cardiovascular disease management. Recent studies have described the phenomenon of clopidogrel resistance but the possible mechanisms are still unclear.PATIENTS AND METHODSThe aim of this study was to compare the characteristics (risk profile, previous diseases, medications, hemorheological variables and plasma von Willebrand factor and soluble P-selectin levels) of patients in whom clopidogrel provided effective platelet inhibition with those in whom clopidogrel was not effective in providing platelet inhibition. 157 patients with chronic cardio- and cerebrovascular diseases (83 males, mean age 61±11 yrs, 74 females, 63±13 yrs) taking 75 mg clopidogrel daily (not combined with aspirin) were included in the study.RESULTSCompared with clopidogrel-resistant patients (35 patients (22%), patients who demonstrated effective clopidogrel inhibition had a significantly lower BMI (26.1 vs. 28.8 kg/m2, p<0.05). Patients with ineffective platelet aggregation were significantly more likely to be taking benzodiazepines (25% vs. 10%) and selective serotonin reuptake inhibitors (28% vs. 12%) (p<0.05). After an adjustment to the risk factors and medications BMI (OR 2.62; 95% CI: 1.71 to 3.6; p<0.01), benzodiazepines (OR 5.83; 95% CI: 2.53 to 7.1; p<0.05) and SSRIs (OR 5.22; 95% CI: 2.46 to 6.83; p<0.05) remained independently associated with CLP resistance. There was no significant difference in the rheological parameters and in the plasma levels of adhesive molecules between the two examined groups.CONCLUSIONThe background of ineffective clopidogrel medication is complex. Drug interactions may play a role on clopidogrel bioavailability, on the other hand, the significant difference in BMI between the two examined groups suggests that clopidogrel therapy should be weight-adjusted.