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Suspected clopidogrel resistance in a patient with acute stent thrombosis

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 226–230 (2006)Cite this article

Abstract

Background A 67-year-old man with supraventricular tachycardia associated with angina underwent coronary angiographic assessment. This investigation revealed mild coronary artery disease in his left main coronary artery and significant stenosis of the ramus medianus (left intermediate artery). A drug-eluting stent was deployed and treatment with clopidogrel and eptifibatide started. The patient subsequently developed chest pain accompanied by hypotension, hypoxemia and electrocardiographic changes that indicated acute myocardial infarction. Emergency angiography revealed occlusion of the ramus medianus despite clopidogrel therapy.

Investigations Coronary angiography, hypercoagulable work up and platelet function tests.

Diagnosis Acute stent thrombosis and suspected clopidogrel resistance, culminating in ST-segment elevation myocardial infarction after percutaneous coronary intervention.

Management Warfarin, aspirin and clopidogrel drug therapy.

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Figure 1: Angiographic findings before, immediately after and 8 h after percutaneous coronary intervention.
Figure 2: Platelet aggregometry curves obtained after antiplatelet drug therapy with clopidogrel.
Figure 3: Platelet aggregometry curves obtained after administration of ticlopidine.

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Acknowledgements

The authors wish to thank Marshfield Clinic Research Foundation for its support through the assistance of L Weis and A Stargardt in the preparation of this manuscript.

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Author notes

  1. HS Vats is a hospitalist, WG Hocking is a hematologist, and SH Rezkalla is Director of Cardiovascular Research and Cardiology

Authors and Affiliations

  1. the Marshfield Clinic, Marshfield, WI, USA

    Hemender S Vats, William G Hocking & Shereif H Rezkalla

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  1. Hemender S Vats
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  2. William G Hocking
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  3. Shereif H Rezkalla
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Correspondence to Shereif H Rezkalla.

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The authors declare no competing financial interests.

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Vats, H., Hocking, W. & Rezkalla, S. Suspected clopidogrel resistance in a patient with acute stent thrombosis. Nat Rev Cardiol 3, 226–230 (2006). https://doi.org/10.1038/ncpcardio0517

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