Prevalence of poor biological response to clopidogrel

Nora Mallouk; Carine Labruyère; Jean-Luc Reny; Céline Chapelle; Michèle Piot; Pierre Fontana; Jean-Christophe Gris; Xavier Delavenne; Patrick Mismetti; Silvy Laporte

doi:10.1160/TH11-03-0202

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2012; 107(03): 494-506
DOI: 10.1160/TH11-03-0202

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Prevalence of poor biological response to clopidogrel

A systematic review

Nora Mallouk

¹Université de Lyon, EA3065, Université Jean Monnet, Saint-Etienne, France

,

Carine Labruyère

²Inserm, CIE3, Saint-Etienne, France

³URCIP, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France

,

Jean-Luc Reny

⁴Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland

⁵EA2992, Faculté de Médecine et Université de Montpellier-Nîmes, Nîmes, France

,

Céline Chapelle

²Inserm, CIE3, Saint-Etienne, France

,

Michèle Piot

¹Université de Lyon, EA3065, Université Jean Monnet, Saint-Etienne, France

,

Pierre Fontana

⁶Division of Angiology and Haemostasis, Faculty of Medicine and University Hospitals of Geneva, Geneva, Switzerland

,

Jean-Christophe Gris

⁵EA2992, Faculté de Médecine et Université de Montpellier-Nîmes, Nîmes, France

,

Xavier Delavenne

¹Université de Lyon, EA3065, Université Jean Monnet, Saint-Etienne, France

,

Patrick Mismetti

¹Université de Lyon, EA3065, Université Jean Monnet, Saint-Etienne, France

²Inserm, CIE3, Saint-Etienne, France

,

Silvy Laporte

¹Université de Lyon, EA3065, Université Jean Monnet, Saint-Etienne, France

²Inserm, CIE3, Saint-Etienne, France

³URCIP, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France

› Author Affiliations

Abstract

Summary

The existence of poor biological response to clopidogrel has been shown in some patients. Despite the increasing number of studies, this phenomenon remains difficult to quantify. We performed a systematic review to estimate the prevalence of poor biological response to clopidogrel and investigate the factors known to modulate this. An exhaustive search was performed. Altogether 171 publications were identified, providing data for a total of 45,664 subjects. The estimated prevalence of poor biological response to clopidogrel ranged from 15.9% to 49.5% according to the platelet function assay employed. The assays most frequently used were light transmittance aggregometry (LTA), the vasodilator-stimulated phosphoprotein (VASP) assay and the Verify -now^® assay. For all these assays, higher cut-off values were associated with a lower prevalence of poor biological response to clopidogrel. However, when choosing a fixed cut-off point for each assay, the prevalence of poor biological response to clopidogrel was highly variable suggesting that other factors could modulate poor biological response to clopidogrel. Finally, none of the studied factors could apparently explain the variability of poor biological response to clopidogrel. This meta-analysis shows that the prevalence of poor biological response depends on the assay employed, the cut-off value and on various unidentified additional factors.

Keywords

Meta-analysis - antiplatelet agents - ischaemic heart disease

Full Text

References

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