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Slide Presentations: Tuesday, November 2, 2010 |

Body Mass Index Does Not Influence Platelet Responsiveness to Clopidogrel in Patients Undergoing Percutaneous Vascular Intervention FREE TO VIEW

Christine Wyrick, MD; Adebola O. Adesanya, MD; Philip E. Greilich, MD; Jonathan Boyd, BS; Ravi Sarode, MD
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University of Texas Southwestern Medical Center, Dallas, TX



Chest. 2010;138(4_MeetingAbstracts):852A. doi:10.1378/chest.9806
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Abstract

PURPOSE: Clopidogrel is routinely administered in patients undergoing endovascular surgery to prevent acute stent thrombosis and subsequent stent occlusion. A fixed loading dose of 300mg followed by a daily dose of 75 mg is given irrespective of individual weight or body mass index (BMI). We hypothesized that increased BMI will be associated with a higher incidence of platelet resistance to clopidogrel.

METHODS: 217 patients who underwent cerebral vascular stenting or aneurysm coiling between 2005 and 2008 were studied. Patients undergoing concurrent treatment with other anti-thrombotic agents were excluded. All patients received 300mg clopidogrel the night prior and on the morning of the procedure. Impedence-based Whole Blood Platelet Aggregation (IWBPA) was performed on each patient 2hrs after treatment with the morning dose of clopidogrel. The relationship between BMI and platelet aggregation was assessed using Pearson’ s correlation coefficient and Wilcoxon rank-sum test was used to test for differences in platelet response to clopidogrel is patients with BMI ≥25 and BMI< 25.

RESULTS: Mean patient age was 58 ± 14.6 years. 32.7% (71) of the patients were male and 67.3% (146) were female. 31.3% (68) patients had a BMI <25 and 68.7% (149) had a BMI ≥25. An IWBPA value of >4Ω; is considered subtherapeutic. The incidence of a subtherapeutic response to clopidogrel was 24%. The correlation between BMI and platelet aggregation was weak (r=0.125; p=0.067). The median (IQR) platelet aggregation in patients with a BMI <25 was not significantly different from those with BMI ≥25(1Ω {0Ω- 6Ω} versus 2Ω {0Ω- 6Ω}; p=0.265.

CONCLUSION: We were unable to detect any significant association between BMI and platelet responsiveness to clopidogrel. BMI may not be a significant factor in clopidogrel dosing. Other factors such as patient co-morbidities, concurrent use of medications such as histamine receptor antagonists and genetic polymorphisms should be considered. The variable response to clopidogrel suggests that testing with IWBPA may be clinically useful.

CLINICAL IMPLICATIONS: Factors other than BMI should be considered for dosing clopidogrel during endovascular intervention.

DISCLOSURE: Christine Wyrick, No Financial Disclosure Information; No Product/Research Disclosure Information

4:30 PM - 06:00 PM


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