Clopidogrel non-responsiveness in patients undergoing percutaneous coronary intervention using the VerifyNow test: frequency and predictors

Objectives

Stent thrombosis and death after percutaneous coronary intervention (PCI) can be caused by a phenomenon known as clopidogrel non-responsiveness which has been shown to occur in approximately 5%–44% of patients. We investigated the responsiveness of clopidogrel in an Iraqi series of cases. Our aim was to determine for the first time the frequency and predictors of clopidogrel non-responsiveness among Iraqi patients with ischaemic heart disease undergoing PCI.

Methods

The study was conducted at the Cardiac Catheterization Center, Baghdad Teaching Hospital, Medical City, from January to May 2014, and included patients who presented for PCI. A platelet aggregation test was performed for those patients using the VerifyNow system.

Results

A total of 115 patients (mean age: 58.3±10.1 years; male sex: 73.9%) were included in the study. 18.3% of the study population were clopidogrel non-responders, which was comparable with the results of a Chinese study (20.28%, P=0.796) but contrasted with other reports from Jordan, Brazil and Thailand. The major independent predictive factor for non-responsiveness in our report was diabetes mellitus (OR 5.96, 95% CI 2.23 to 13.71; P=0.001), followed by hypertension (OR 4.135, P=0.035), obesity (OR 3.44, P=0.037) and male sex (OR 3.039, P=0.045). Previous use of clopidogrel (OR 0.17, P=0.02) and younger age (OR 0.72, P=0.026) were identified as protective factors.

Conclusions

In this study, 18.3% of patients were non-responders to clopidogrel and the major independent predictive factors for non-responsiveness were diabetes mellitus, hypertension, obesity and male sex.

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