Genetics and Plavix/Iscover play role in risk of post-stent thrombosis

A new study published in JAMA shows that it is possible to identify genetic or other factors in patients who have received a coronary stent which give this sub-population a higher potential risk of experiencing a blood clot within the stent. Despite the use of dual antiplatelet therapy - DAPT; aspirin and Plavix/Iscover (clopidogrel), from BMS and Sanofi-Aventis - which reduces cardiovascular events after PCI by more than 80 percent, thrombosis due to the stent creates a mortality rate of up to 40%. New research, led by Guillaume Cayla of the Pitie-Salpetriere Hospital in Paris, examined 23 genetic variants in 123 patients who had undergone PCI with a definite early stent thrombosis, and this revealed that in 15 of these genetic variations, 3 were related to Plavix/Iscover metabolism and platelet function. As for clinical control of the risk of early stent thrombosis, the team identified two key factors: the Plavix/Iscover loading dose and the Plavix/Iscover interaction with proton pump inhibitors. Combining a knowledge of genetic make-up with these clinical factors should help reduce the risk of stent thrombosis in some patients. See: "Clinical, Angiographic, and Genetic Factors Associated With Early Coronary Stent Thrombosis" Guillaume Cayla et al. (JAMA 2011;306(16):1765-1774. doi: 10.1001/jama.2011.1529)