, Volume 31, Issue 2, pp 233-234
Date: 19 Nov 2010

A case of resistance to clopidogrel and prasugrel after percutaneous coronary angioplasty

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Dual antiplatelet therapy (aspirin and clopidogrel) is the standard therapy to prevent stent thrombosis after percutaneous coronary angioplasty. Clopidogrel is a prodrug which requires two-step activation through oxidative metabolism, involving various cytochrome P-450 (CYP) enzymes [1]. Carriers of defective alleles for CYP2C19 (*2) and CYP2C9 (*2, *3) have a reduced antiplatelet effect in response to clopidogrel [2, 3]. In addition, CYP3A4 in vivo activity measured by the erythromycin breath test is significantly correlated with the ability of clopidogrel to inhibit platelet aggregation [4]. Lastly, it has been reported that omeprazole and atorvastatin—which are inhibitors of CYP2C19 and CYP3A4, respectively—can reduce the effect of clopidogrel in man [5, 6]. Thus, there is clinical evidence that the activity of at least three cytochromes determines the effectiveness of clopidogrel in vivo.

We report a case of early stent thrombosis associated with clopidogrel resistance in a 60-year-