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Case  Report

Subacute stent thrombosis in a patient with type 2 diabetes and clopidogrel resistance: A case report 

Mei Chen Zhou, Shi Ping Cao, Hong Lan Zhong, and Ping Zheng

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Volume 58 (2020) p. 449 - 453

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 58 – No. 8/2020 (449-453)

Subacute stent thrombosis in a patient with type 2 diabetes and clopidogrel resistance: A case report 

Mei Chen Zhou¹, Shi Ping Cao², Hong Lan Zhong¹, and Ping Zheng³

¹Department of Pharmacy, Guangzhou Chest Hospital, ²Department of Cardiology, and ³Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, China
Objective: Clopidogrel has become the mainstay oral antiplatelet regimen for recurrent ischemic event prophylaxis after acute coronary syndromes or stent placement. Stent thrombosis is considered a multifactorial problem that mostly occurs due to clopidogrel resistance. We report a case of subacute stent thrombosis in a CYP2C19*2 reduced-function allele carrier.
Case summary: A 56-year-old Chinese male diabetic patient suffered from acute myocardial infarction and underwent successful percutaneous coronary intervention (PCI) of the left anterior descending coronary artery (LAD) with two drug eluting stents (DESs). He was treated with a loading dose of aspirin 300 mg and ticagrelor 180 mg before stent placement. Ticagrelor was switched to clopidogrel of 75 mg maintenance dose, after emergency PCI. Stent thrombosis appeared 8 days after stent placement. The patient was found to be a CYP2C19*2 reduced-function allele carrier with type 2 diabetes. After intravenous administration of tirofiban, balloon angioplasty was performed, resulting in thrombolysis in myocardial infarction (TIMI) III antegrade flow.
Conclusion: The present case demonstrates that both diabetes mellitus and carriage of CYP2C19*2 allele are associated with a reduced response to clopidogrel in the setting of this standard dose of clopidogrel and a high risk of stent thrombosis. CYP2C19 genetic testing seems to be helpful for identifying patients-at-risk, and optimal antiplatelet regimen should be considered in these fragile populations.Correspondence to:
Ping Zheng, MPharm
Department of  Pharmacy, Nanfang Hospital
Southern Medical University
Heng zhi Gang Road 62#, Yuexiu District
Guangzhou, 510095 China
Email: [email protected]

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