Thromb Haemost 2012; 107(03): 494-506
DOI: 10.1160/TH11-03-0202
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Prevalence of poor biological response to clopidogrel

A systematic review
Nora Mallouk
1   Université de Lyon, EA3065, Université Jean Monnet, Saint-Etienne, France
,
Carine Labruyère
2   Inserm, CIE3, Saint-Etienne, France
3   URCIP, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
,
Jean-Luc Reny
4   Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
5   EA2992, Faculté de Médecine et Université de Montpellier-Nîmes, Nîmes, France
,
Céline Chapelle
2   Inserm, CIE3, Saint-Etienne, France
,
Michèle Piot
1   Université de Lyon, EA3065, Université Jean Monnet, Saint-Etienne, France
,
Pierre Fontana
6   Division of Angiology and Haemostasis, Faculty of Medicine and University Hospitals of Geneva, Geneva, Switzerland
,
Jean-Christophe Gris
5   EA2992, Faculté de Médecine et Université de Montpellier-Nîmes, Nîmes, France
,
Xavier Delavenne
1   Université de Lyon, EA3065, Université Jean Monnet, Saint-Etienne, France
,
Patrick Mismetti
1   Université de Lyon, EA3065, Université Jean Monnet, Saint-Etienne, France
2   Inserm, CIE3, Saint-Etienne, France
,
Silvy Laporte
1   Université de Lyon, EA3065, Université Jean Monnet, Saint-Etienne, France
2   Inserm, CIE3, Saint-Etienne, France
3   URCIP, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
› Author Affiliations
Further Information

Publication History

Received: 28 March 2011

Accepted after major revision: 14 January 2011

Publication Date:
22 November 2017 (online)

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Summary

The existence of poor biological response to clopidogrel has been shown in some patients. Despite the increasing number of studies, this phenomenon remains difficult to quantify. We performed a systematic review to estimate the prevalence of poor biological response to clopidogrel and investigate the factors known to modulate this. An exhaustive search was performed. Altogether 171 publications were identified, providing data for a total of 45,664 subjects. The estimated prevalence of poor biological response to clopidogrel ranged from 15.9% to 49.5% according to the platelet function assay employed. The assays most frequently used were light transmittance aggregometry (LTA), the vasodilator-stimulated phosphoprotein (VASP) assay and the Verify -now® assay. For all these assays, higher cut-off values were associated with a lower prevalence of poor biological response to clopidogrel. However, when choosing a fixed cut-off point for each assay, the prevalence of poor biological response to clopidogrel was highly variable suggesting that other factors could modulate poor biological response to clopidogrel. Finally, none of the studied factors could apparently explain the variability of poor biological response to clopidogrel. This meta-analysis shows that the prevalence of poor biological response depends on the assay employed, the cut-off value and on various unidentified additional factors.