Acute Stent Thrombosis Post Primary PCI in a Patient with Aspirin and Clopidogrel Resistance A Case Report

Platelets play a central role in the pathogenesis of atherothrombosis. Dual antiplatelet therapy with combination of clopidogrel and aspirin has been shown to reduce ischemic events in patients undergoing percutaneous coronary intervention (PCI) and stenting. Although dual antiplatelet therapy reduces the risk of cardiovascular episodes after PCI, a substantial number of incidents continue to occur. Aspirin and clopidogrel resistance are emerging clinical entities with potentially severe consequences such as recurrent myocardial infarction, which is a rare condition. However the current clinical guidelines do not support routine screenings for antiplatelet resistance because standardized objective screening has not yet been established. We reported a 37 years-old male patient that suffered recurrent myocardial infarction after succesful primary PCI. Chest pain and acute ST elevation on ECG resolved during administration of integrilin. We suspected aspirin and clopidogrel resistance, so the therapy was switched to ticagrelor, trifl usal, aspirin and integrilin. Angiography two days later showed patent stent in LAD without any thrombus or dissections. Later the patient was found out to be aspirin resistance and suspected of clopidogrel resistance. After the patient was stable, he was sent home with ticagrelor and cardioaspirin. This case report describes mechanism and treatment options for aspirin and clopidogrel resistance. Keywords: Platelets, Aspirin, Clopidogrel, Drug resistance, Percutaneus Coronary Intervention.