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Clopidogrel loading dose adjustment according to platelet reactivity monitoring in patients carrying the 2C19 2* loss-of function polymorphism. Laurent Bonello, MD Unité de cardiologie interventionnelle Pôle de cardiologie Hôpital universitaire nord de Marseille FRANCE.
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Clopidogrel loading dose adjustment according to platelet reactivity monitoring in patients carrying the 2C19 2* loss-of function polymorphism.
Laurent Bonello, MD
Unité de cardiologie interventionnelle
Pôle de cardiologie
Hôpital universitaire nord de Marseille
Speaker’s name: BONELLO Laurent
I have the following potential conflicts of interest to report:
Research contracts Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
xI do not have any potential conflict of interest
Bonello et al. Heart 2009
Bonello et al. JACC 2010 In press.
PR monitoring enables optimal PR inhibition to be reached which translates into a reduction in thrombotic events post-PCI without increased bleeding.
Bonello et al. AJC 2009.
Simon T. et al. N EJM 2008; Megat et al. NEJM 2008.
CV Death / MI / Stroke 12-15 months
Megat et al. NEJM 2008.
prospective multicenter study
dose adjustment is performed by using up-to three additional LD of clopidogrel until a VASP <50% was obtained.
HTPR: VASP ≥50%
.Primary end-point: PR <50% in « HTPR » patients
.Secondary: In-hospital bleeding and MACE
11 homozygotes (2.7%) and 123 heterozygotes (32.6%).
VASP index was significantly higher than that of WT homozygotes (61.7 ±18.4 vs 49.2 ±24.2%; p<0.001).
104/134 (77.6%) were considered to have HTPR.
After a 2nd LD, the VASP index was significantly decreased in these patients (69.7 ±10.1 vs 50.6 ±17.6 %; p <0.0001).RESULTS
Biological impact of a 2nd clopidogrel LD in carriers of CYP 2C19 2* with HTPR.
2 MACE : 1 stroke and 1 SAT (Htz with FDA).
4 minor TIMI bleedings: Hmz WT.
Since studies have demonstrated the clinical benefit of dose-adjustement in patients with HTPR undergoing PCI, this therapeutic strategy may improve the prognosis of carriers of this loss-of function polymorphism.CONCLUSION
Mancini Julien, Saut Noémie, Bonello Nathalie
Giacomoni Marie-Paule, Dignat-George Françoise, Camoin-Jau Laurence
Marie-Christine Alessi, Karine Berthaux.Aknowledgements