Repetitive stent thrombosis in a patient who had resistance to both clopidogrel and prasugrel

Abstract

Clopidogrel resistance is associated with stent thrombosis. Prasugrel achieves greater platelet inhibition with less variability among patients than does clopidogrel. Thus, a patient who had stent thrombosis due to clopidogrel resistance may receive prasugrel to prevent repeated episodes of stent thrombosis. This case report describes a case of repetitive stent thrombosis in which resistance not only to clopidogrel, but also to prasugrel, was observed. <Learning objective: In the face of clopidogrel resistance, prescribing prasugrel may be an acceptable treatment option. However, cross-unresponsiveness may be observed between clopidogrel and prasugrel. Thus, platelet function assay should be performed in patients with stent thrombosis, even when clopidogrel is replaced with prasugrel.>.

Keywords: Clopidogrel resistance; Platelet function test; Prasugrel resistance; Stent thrombosis.

Fig. 1

(A) Coronary angiography showing a 75% narrowing in the mid-right coronary artery. (B) Angiography shows a good result after drug-eluting stent implantation. (C) Four months later, stent thrombosis is observed.

Fig. 2

(A) Intravascular ultrasound (IVUS) imaging demonstrates optimal stent expansion in the mid-right coronary artery. (B) IVUS imaging shows no stent underexpansion after drug-eluting stent implantation for stent thrombosis.

Fig. 3

(A) The third stent thrombosis develops. (B) Angiography shows a good result. (C) Two months later, the fourth stent thrombosis is observed. (D) Angiography demonstrates a good result. (E) Three months later, follow-up angiography shows no restenosis.