Stent thrombosis in a patient with acute coronary syndrome without ST segment elevation with high residual platelet reactivity

Main Article Content

D. A. Mansurova
L. K. Karazhanova
A. B. Sugraliev


Stent thrombosis is a dangerous life-threatening condition, which is more frequent during the first month after stent implantation. Currently, there are several possible schemes for preventing stent thrombosis with clopidogrel and stronger P2Y12 receptor inhibitors. The article describes the clinical case of stent thrombosis in a patient with clopidogrel resistance against the background of carrying the allelic variant of the gene CYP2C19*2, a «slow metabolizer of clopidogrel». Despite the recommended use of high doses of clopidogrel to improve the clinical outcome in patients with a homozygote CYP2C19*2 (*2/*2), this clinical case showed high doubtfulness of such tactics. In such cases, the use of more potent inhibitors of P2Y12 receptors is justified, since it allows improving clinical outcomes of mechanical revascularization.

Article Details


Острый коронарный синдром, реваскуляризация, тромбоз стента, ингибиторы P2Y12-рецепторов, клопидогрель, ген CYP2C19


Mirzaev KB, Andreev DA, Syichev DA. Evaluation of platelet aggregation in clinical practice. Ratsionalnaya farmakoterapiya v kardiologii [Rational pharmacotherapy in cardiology]. 2015;7:85–91 (in Ukr.).

Casserly I.P., Goldstein J.A., Lasala J.M. Late stent thrombosis in the nonbrachytherapy population: a real phenomenon? Catheter. Cardiovasc. Interv. 2003;59(4):504–8.

Conclusion of Interdisciplinary Expert Council of Russian Association of Angiologists and Vascular Surgeons, Russian Scientific Society of Endovascular Surgeons and Interventional Radiologists, National Stroke Association N.S.I.S. The significance of platelet functional activity testing in the prevention of cardiovascular complications in patients receiving antiplatelet therapy. Ration Pharmacother Cardiol. 2014;10(6):679–687.

Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW. Clinical end points in coronary stent trials: A case for standardized definitions. Circulation. 2007;115(17):2344–2351.

Cutlip DE, Baim DS, Ho KK, Popma JJ, Lansky AJ, Cohen DJ, Carrozza JP Jr, Chauhan MS, Rodriguez O, Kuntz RE. Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation. 2001;103(15):1967–71.

Garabedian T, Alam S. High residual platelet reactivity on clopidogrel: its significance and therapeutic challenges overcoming clopidogrel resistance. Cardiovasc. Diagn. Ther. 2013;3(1):23–37.

Guo YM, Zhao ZC, Zhang L, Li HZ, Li Z, Sun HL. CYP2C19 polymorphisms in acute coronary syndrome patients undergoing clopidogrel therapy in Zhengzhou population. Genet. Mol. Res. 2016;15(2).

Gurbel PA, Bliden KP, Hiatt BL, O'Connor CM. Clopidogrel for Coronary Stenting. Circulation. 2003;107(23).

Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, Airoldi F, Chieffo A, Montorfano M, Carlino M, Michev I, Corvaja N, Briguori C, Gerckens U, Grube E, Colombo A. Incidence, Predictors, and Outcome of Thrombosis After Successful Implantation of Drug-Eluting Stents. JAMA. 2005;293(17):2126.

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur. Heart J. 2017;11:1–66.

Mega JL, Simon T, Collet JP, Anderson JL, Antman EM, Bliden K, Cannon CP, Danchin N, Giusti B, Gurbel P, Horne BD, Hulot JS, Kastrati A, Montalescot G, Neumann FJ, Shen L, Sibbing D, Steg PG, Trenk D, Wiviott SD, Sabatine MS. Reduced-Function CYP2C19 Genotype and Risk of Adverse Clinical Outcomes Among Patients Treated With Clopidogrel Predominantly for PCI. JAMA. 2010;304(16):1821.

Mehta SR, Tanguay JF, Eikelboom JW, Jolly SS, Joyner CD, Granger CB, Faxon DP, Rupprecht HJ, Budaj A, Avezum A, Widimsky P, Steg PG, Bassand JP, Montalescot G, Macaya C, Di Pasquale G, Niemela K, Ajani AE, White HD, Chrolavicius S, Gao P, Fox KA, Yusuf S. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet (London, England). 2010; 376(9748):1233–43.

Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O'Shaughnessy C, Caputo RP, Kereiakes DJ, Williams DO, Teirstein PS, Jaeger JL, Kuntz RE; Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N. Engl. J. Med. 2003;349(14):1315–23.

Moussa I, Di Mario C, Reimers B, Akiyama T, Tobis J, Colombo A. Subacute stent thrombosis in the era of intravascular ultrasound-guided coronary stenting without anticoagulation: frequency, predictors and clinical outcome. J. Am. Coll. Cardiol. 1997;29(1):6–12.

Ong AT, Hoye A, Aoki J, van Mieghem CA, Rodriguez Granillo GA, Sonnenschein K, Regar E, McFadden EP, Sianos G, van der Giessen WJ, de Jaegere PP, de Feyter P, van Domburg RT, Serruys PW. Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation. J. Am. Coll. Cardiol. 2005;45(6):947–953.

Postmarket Drug Safety Information for Patients and Providers - FDA Drug Safety Communication: Reduced effectiveness of Plavix (clopidogrel) in patients who are poor metabolizers of the drug.

Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur. Heart J. 2016;37(3):267–315.

Scott SA, Sangkuhl K, Stein CM, Hulot JS, Mega JL, Roden DM, Klein TE, Sabatine MS, Johnson JA, Shuldiner AR. Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C19 Genotype and Clopidogrel Therapy : 2013 Update. 2013;94(3):317–323.

Serruys PW, Unger F, Sousa JE, Jatene A, Bonnier HJ, Schönberger JP, Buller N, Bonser R, van den Brand MJ, van Herwerden LA, Morel MA, van Hout BA. Comparison of Coronary-Artery Bypass Surgery and Stenting for the Treatment of Multivessel Disease. N. Engl. J. Med. 2001;344(15):1117–1124.

Shevela AI, Slepukhina AA, Zelenskaya EM, Seredina TA, Lifshits GI. Algorithm for selection of individual therapy with clopidogrel in vascular surgical practice. Angiol. Sosud. Khir. 22(4):177–183.

Stimpfle F, Karathanos A, Droppa M, Metzger J, Rath D, Müller K, Tavlaki E, Schäffeler E, Winter S, Schwab M, Gawaz M, Geisler T. Impact of point-of-care testing for CYP2C19 on platelet inhibition in patients with acute coronary syndrome and early dual antiplatelet therapy in the emergency setting. Thromb. Res. 2014;134(1):105–10.

Stone GW, Ellis SG, Cox DA, Hermiller J, O'Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Popma JJ, Russell ME. Polymer-Based, Paclitaxel-Eluting Stent in Patients with Coronary Artery Disease. N. Engl. J. Med. 2004;350(3):221–231.

Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, Jüni P, Kastrati A, Kolh P, Mauri L, Montalescot G, Neumann FJ, Petricevic M, Roffi M, Steg PG, Windecker S, Zamorano JL, Levine GN. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur. Heart J. 2017;November:1–48.

Wang F, Stouffer GA, Waxman S, Uretsky BF. Late coronary stent thrombosis: early vs. late stent thrombosis in the stent era. Catheter. Cardiovasc. Interv. 2002; 55(2):142–7.

Wei Y.-Q. Cytochrome P450 CYP 2C19*2 Associated with Adverse 1-Year Cardiovascular Events in Patients with Acute Coronary Syndrome. PLoS One. 2015;10(7):1–8.

Wenaweser P, Rey C, Eberli FR, Togni M, Tüller D, Locher S, Remondino A, Seiler C, Hess OM, Meier B, Windecker S. Stent thrombosis following bare-metal stent implantation: success of emergency percutaneous coronary intervention and predictors of adverse outcome. Eur. Heart J. 2005;26(12):1180–7.

Xiong R, Liu W, Chen L, Kang T, Ning S, Li J. A randomized controlled trial to assess the efficacy and safety of doubling dose clopidogrel versus ticagrelor for the treatment of acute coronary syndrome in patients with CYP2C19*2 homozygotes. Int. J. Clin. Exp. Med. 2015;8(8):13310–13316.

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>