The Individualized Antiplatelet Therapy Following Percutaneous Coronary Intervention: A Case Report And Literature Review

Acute coronary syndrome (ACS), as a significant cardiovascular disease entity, is associated with risks of mortality and morbidity, such as heart failure, myocardial infarction, and ventricular arrhythmia et al. Current guidelines and cardiological experts recommend the antithrombotic therapy, with dual antiplatelet therapy consisting of a low-dose acetylsalicylic acid and ADP P2Y12 inhibitors with clopidogrel, ticagreior or prasugrel as the first line to reduce the recurrent ischaemic events. As another risk factor for mortality and disability from thromboembolism, atrial fibrillation (AF) brought massive health burdens of the world. The antithrombotic treatment is a particular challenge in patients who present with both AF and ACS. Clopidogrel resistance refers to the occurrence of adverse cardiovascular events despites adequate antiplatelet treatment and compliance. Studies have demonstrated that clopidogrel resistance is related to CYP2C19 gene polymorphism. In our case report, we analysis an atrial fibrillation patient with clopidogrel resistance concurrence ACS following percutaneous coronary intervention. We introduce the diagnosis clopidogrel resistance by LTA and Verifynow, and explicit the CYP2C19 loss of function allele *3 variants might be responsible for clopidogrel resistance. Furthermore, we introduce the adjustment of antiplatelet treatment and the adverse drug reaction in the patient. Finally, under the circumstance of discontinuing clopidogrel, this ciopidogrel resistance patient suffered from a cerebral hemorrhage. The optimal individualized antiplatelet therapy in patients with clopidogrel resistance following PCI, especially concurrence atrial fibrillation still need further to be studied.