Effect of platelet antigen polymorphism on platelet inhibition by aspirin, clopidogrel, or their combination

Glen E. Cooke, Yiwen Liu-Stratton, Amy K. Ferketich, Melvin L. Moeschberger, David J. Frid, Raymond D. Magorien, Paul F. Bray, Philip F. Binkley, Pascal Goldschmidt-Clermont

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Abstract

OBJECTIVES: We studied the modifier effect of platelet antigen polymorphism (PlA2) on platelet inhibition by acetylsalicylic acid (ASA, i.e., aspirin), clopidogrel, or their combination in patients with coronary heart disease. BACKGROUND: Clopidogrel, when administered with ASA, was shown to significantly improve the outcome of patients with acute coronary syndromes compared with patients receiving only ASA. We have shown previously that the effect of ASA on platelets is modified by the glycoprotein IIIa single nucleotide polymorphism PlA2. Hence, an important pharmacogenetic question remains whether the antiplatelet effect of clopidogrel is uniform for all patients or, like acetylsalicylic acid, more selective. METHODS: Thirty PlA1/A1 and 30 PlA1/A2 patients were assigned randomly to ASA 325 mg/day, clopidogrel 75 mg/day, or both. After 10 days, platelet function was studied. RESULTS: Clopidogrel provided stronger platelet inhibition than ASA with adenosine diphosphate as the agonist, and combination therapy resulted in greater inhibition than either inhibitor used alone (p < 0.0001). The use of ASA resulted in greater inhibition compared with clopidogrel with epinephrine (p < 0.0001) and collagen as agonists (p < 0.0001). With collagen as the agonist, platelets from PlA1/A2 donors were markedly and significantly less inhibited by ASA (p = 0.005). In contrast, with clopidogrel, no significant difference could be detected between inhibition of Pl A1/A1 and PlA1/A2 platelets. CONCLUSIONS: The combination of ASA and clopidogrel appears superior to either agent alone in inhibiting platelet function. PlA2 functions as an important modifier for platelet responsiveness to ASA but not to clopidogrel. These findings could have significant impact on the future design of pharmacogenetic antithrombotic strategies for patients with coronary heart disease.

Original languageEnglish
Pages (from-to)541-546
Number of pages6
JournalJournal of the American College of Cardiology
Volume47
Issue number3
DOIs
StatePublished - Feb 7 2006
Externally publishedYes

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Cooke, G. E., Liu-Stratton, Y., Ferketich, A. K., Moeschberger, M. L., Frid, D. J., Magorien, R. D., Bray, P. F., Binkley, P. F., & Goldschmidt-Clermont, P. (2006). Effect of platelet antigen polymorphism on platelet inhibition by aspirin, clopidogrel, or their combination. Journal of the American College of Cardiology, 47(3), 541-546. https://doi.org/10.1016/j.jacc.2005.09.034