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Ryan O’Keefe: Clopidogrel Non-Responders and the Risk of Stent Thrombosis
Ryan O'Keefe/pennmedicine.org
Aug 19, 2026, 17:34

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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bleeding disorders Blood clopidogrel Clopidogrel Non-responders Health Hematology Hemostasis Hemostasis News Hemostasis Today hepatic CYP450 Medicine platelets prasugrel Ryan O'Keefe thrombosis ticagrelor
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