Université de Lyon, EA3065, Université Jean Monnet, Saint-Etienne, France.
Thromb Haemost. 2012 Mar;107(3):494-506. doi: 10.1160/TH11-03-0202. Epub 2012 Jan 25.
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 Verifynow® 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.
已有研究表明，部分患者对氯吡格雷的生物反应较差。尽管相关研究不断增加，但这种现象仍难以量化。我们进行了一项系统评价，以评估氯吡格雷生物反应不良的发生率，并探讨已知可调节该反应的因素。进行了全面检索。共确定了 171 篇出版物，为总共 45664 名受试者提供了数据。根据所使用的血小板功能检测方法，氯吡格雷生物反应不良的估计发生率在 15.9%至 49.5%之间。最常使用的检测方法是光透射聚集测定法（LTA）、血管扩张刺激磷蛋白（VASP）检测法和 VerifyNow®检测法。对于所有这些检测方法，较高的截止值与较低的氯吡格雷生物反应不良发生率相关。然而，当为每种检测方法选择固定的截止值时，氯吡格雷生物反应不良的发生率差异很大，表明可能存在其他因素调节氯吡格雷的生物反应不良。最后，研究的因素均不能明显解释氯吡格雷生物反应不良的可变性。这项荟萃分析表明，氯吡格雷生物反应不良的发生率取决于所使用的检测方法、截止值以及各种未识别的其他因素。
