OC 34.3 - Acetylsalicylic acid and clopidogrel resistance in Mexico: a 15-year follow-up

Monday, June 24, 2024

10:00 – 10:15 ICT

Room: Ballroom B4

Presenting Author(s)

Emely J. Soriano, MD

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico City, Distrito Federal, Mexico

Co-Author(s)

Adriana G. Garcia

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico City, Distrito Federal, Mexico
Stephania Sandoval Ocampo, Hematologist

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Ciudad de méxico, Mexico City, Mexico
TM

Tania Marisol Martinez Garcia

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico City, Distrito Federal, Mexico
Margarita M. Thomas, MD

Medical Resident on Thrombosis and Hemostasis
1Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico city, Distrito Federal, Mexico
ML

María Graciela Leal Gutiérrez

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico City, Distrito Federal, Mexico
Andric Cuevas-Juárez, MD

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico city, Distrito Federal, Mexico
Jose A. Aguilar

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Ciudad de México, Distrito Federal, Mexico
Marilyn G. Mendoza, MD

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico City, Distrito Federal, Mexico
Abraham S. Majluf

Head of the thrombosis and hemostasis unit
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico City, Distrito Federal, Mexico

Background: Treatment directed towards platelet inhibition with acetylsalicylic acid (ASA) and/or clopidogrel (CLO) has a major role in the management of arterial thrombotic events and their complications. However, in international literature, it is described that 20-60% of patients suffer recurrent cardiovascular events due to what is considered as an inadequate antiplatelet effect or resistance. Resistance is defined by the loss of the antiplatelet effect measured by platelet aggregation (>15%). In Mexico, the presence of polymorphisms in the alleles C3435T and CYP2C19*2 associated with CLO resistance has been described. This study evaluates the resistance to ASA and CLO in a Mexican population.

Aims: To describe the resistance to ASA and CLO in a Mexican population as well as the recurrence of thrombotic events associated to resistance to antiplatelet therapy.

Methods: A prospective, descriptive, controlled, randomized, single blind, 15-year follow-up study of patients with atherothrombotic disease requiring secondary prevention. Development of resistance to chronic use of ASA or CLO at any time as well as the associated recurrent ischemic events in adult men or women were evaluated. Resistance was defined according to international criteria as >15% of ADP- or arachidonic acid (AA)-induced platelet aggregation using a two-channel Chrono-log 700 aggregometer.

Results: The sample included 3,585 patients aged 16-93 years-old. They were 1,778 men and 1,807 women. Table 1 summarizes the resistance in each group of treatment including patients treated with combined therapy ASA + CLO. Table 2 shows the rate of thrombotic events and the pattern of resistance trough time in each group of treatment.

Conclusion(s): In the Mexican population studied long-term resistance to ASA is almost absent, while resistance to CLO is highly frequent even shortly after beginning of therapy. These findings significantly correlate with the occurrence of recurrent thrombotic events.