Türk Beyin Damar Hast Derg. 2015; 21(2): 103-107 | DOI: 10.5505/tbdhd.2015.27146

Analyzing the Effect of Comorbidities and Drug Usage in Clopidogrel Unresponsive Patients

Eda Kýlýç Çoban, Elmir Xanmemmedow, Aysun Soysal
Bakýrköy Education And Training Hospital, 3rd Neurology Department, Ýstanbul

INTRODUCTION: OBJECTIVE: Clopidogrel is a widely used antiplatelet in vascular events. However multiple drug prescriptions increase the risk for drug-drug interactions. The purpose of the study is to rule out the factors leading to clopidogrel responsiveness including the comorbidities and drugs.
METHODS: In this retrospective study, ischemic stroke patients who were being treated with clopidogrel for at least one year were eligible for enrollment.Clopidogrel resistance was measured with MEA. The comorbities and the medical treatment of the patients were noted.
RESULTS: 92 patients were included the study. 49 % of them were male and the median age was 69,19±12,08. 44.6 % of the patients were unresponsive to clopidogrel. Hypertension, hyperlipidemia and diabetes mellitus were not associated with a decreased response to clopidogrel. Similarly, we did not observe any drug-drug interactions between clopidogrel and oral antidiabetics, insulin, antihypertensives, antilipidemics and proton pump inhibitors. Age and gender were also not associated with clopidogrel responsiveness.
DISCUSSION AND CONCLUSION: CONCLUSION: Our study indicates that 45% of patients had a decrease response to clopidogrel. However we found no relation between clopidogrel resistance and the factors mentioned in previous studies. This could be attributed to other unknown factors leading to drug resistance.

Keywords: clopidogrel, drug interaction, diabetes, hypertension, hyperlipidemia

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Klopidogrel Direnci Mevcut Hastalarda Eþlikçi Komorbiditelerin ve Kullanýlan Ýlaçlarýn Etkilerinin Sorgulanmasý

Eda Kýlýç Çoban, Elmir Xanmemmedow, Aysun Soysal
Bakýrköy Ruh Ve Sinir Hastalýklarý Eðitim Ve Araþtýrma Hastanesi, 3. Nöroloji Kliniði, Ýstanbul

GÝRÝÞ ve AMAÇ: AMAÇ: Klopidogrel vasküler hastalýklarda yaygýn olarak kullanýlan bir antiplatelettir. Ancak antiplatelet ilaçlarla birlikte yapýlan çoklu ilaç uygulamalarý ilaç-ilaç etkileþim riskini artýrmaktadýr. Bu çalýþmanýn amacý, klopidogrel direncine neden olan komorbiditeleri ve ilaçlarý tespit etmektir.
YÖNTEM ve GEREÇLER: YÖNTEMLER:
Bu retrospektif çalýþmaya en az 1 yýldýr klopidogrel kullanýmý olan iskemik inme hastalarý dahil edildi. Hastalarýn klopidogrel direnci Multiple Electrod Aggregometry (MEA) yöntemi ile ölçüldü. Hastalarýn komorbiditeleri ve aldýklarý medikal tedaviler ( proton pompa inhibitörleri, antihipertansifler, antilipidemikler, oral antidiyabetikler, insülin) kaydedildi.

BULGULAR: Çalýþmaya 92 hasta dahil edildi. Hastalarýn 49’u erkek, yaþ ortalamasý 69,19±12,08 idi. % 44.6 hastada klopidogrel direnci gözlendi. Direncin diabet, hipertansiyon, hiperlipidemi varlýðý ile iliþkisi bulunmadý. Benzer þekilde hastalarýn oral antidiabetik, insülin, proton pompa inhibitörleri, antilipidemik, antihipertansif (β bloker, kalsiyum kanal blokeri, anjiotensin konverting enzim inhibitörleri (ACEÝ), anjiotensinojen reseptör blokeri (ARB), diüretik) kullanýmlarý ile klopidogrel direnci arasýnda anlamlý iliþki saptanmadý. Yaþ ve cinsiyet açýsýndan da klopidogrel direnci ile iliþki tespit edilmedi.
TARTIÞMA ve SONUÇ: SONUÇ: Çalýþmamýz % 45 oranýnda klopidogrele yanýtsýzlýk olduðunu göstermektedir. Oysa ki çalýþmamýzda klopidogrel direncini artýran klinik bir belirteç tespit edilememiþtir. Literatürde tespit edilen direnç geliþimine yol açan risk faktörleri bizim çalýþmamýzda anlamlý bulunmamýþtýr. Henüz bilinmeyen baþka faktörler de direnç geliþiminde etkili olabilir.

Anahtar Kelimeler: klopidogrel, direnç, ilaç etkileþimi, diabet, hipertansiyon, hiperlipidemi

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