Curriculum in CardiologyClopidogrel nonresponsiveness in patients undergoing percutaneous coronary intervention with stenting: A systematic review and meta-analysis
Section snippets
Methods
We searched MEDLINE (from January 1966 until October 2006), EMBASE (from January 1974 until October 2006), the Cochrane Central Register of Controlled trials (CENTRAL) (from 1800 until October 2006), and Web of Science (from 1945 until October 2006), using predefined search terms (Appendix A). We used no language restrictions. Furthermore, we searched reference lists of relevant studies and reading reviews, editorials, and letters on this topic. Authors of identified appropriate studies were
Results
By subsequent screening and assessment of titles, abstracts, and full-text articles, we included 25 studies that incorporated a total of 3688 patients (Figure 1). Nineteen full-text articles13, 14, 15, 16, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36 and 3 meeting abstracts37, 38, 39 (2574 patients) addressed the prevalence of laboratory clopidogrel nonresponsiveness in patients undergoing PCI, whereas clinical consequences were studied in 10 full-text articles14, 25, 31, 32, 33,
Discussion
Among studies in patients on clopidogrel to prevent cardiovascular events after PCI, our meta-analysis showed an overall prevalence of 21% of laboratory-defined clopidogrel nonresponsiveness. A wide range of prevalences was found, which is largely explained by differences in time between clopidogrel loading and determination of nonresponsiveness and loading dose of clopidogrel used. Our findings indicate that patients ex vivo labeled clopidogrel resistant have an increased risk of stent
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