Ryan O’Keefe: Clopidogrel Non-Responders and the Risk of Stent Thrombosis
Ryan O’Keefe, Internal Medicine Resident at the Hospital of The University of Pennsylvania, Creator of Point of Care Medicine, shared a post on X:
“Daily Pearl(s):
Clopidogrel Non-responders
Clopidogrel is a prodrug requiring hepatic CYP450 enzyme activation (primarily CYP2C19).
Genetic differences can lead to a ‘nonresponder‘ or ‘hyporesponder‘ state.
In these patients, usual doses of clopidogrel won’t be effective and thus increase the risk of thrombosis after receiving a stent until there has been adequate endothelialization (which can take weeks to months).
Platelet function testing can test for reduced platelet inhibition from clopidogrel.
In such cases, future anti-thrombotic medication should prioritize alternative options like ticagrelor or prasugrel rather than re-challenging with clopidogrel.
Source: Annals of IM – Clopidogrel Nonresponsiveness Mimicking Endocarditis After PFO-Occlusion Combining Aspiration, Retrieval, and Laboratory Assessment for Diagnostic-Therapeutic Work-Up.
Learn more clinical pearls from the Point of Care Medicine Substack!”
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