Background
Clopidogrel resistance is a well-described phenomenon that has been linked to adverse
cardiovascular events in patients with coronary artery disease. The impact of clopidogrel
resistance in patient outcomes after vascular and endovascular surgery is not well-established.
Methods
Using preferred reporting items for systematic reviews and meta-analyses (PRISMA)
guidelines, a literature review with the medical subject headings (MeSH) terms “(clopidogrel
resistance) and (vascular)”, “(clopidogrel resistance) and (vascular surgery)”, “(clopidogrel
resistance) and (endovascular)”, and “(clopidogrel resistance) and (endovascular surgery)”
was performed in PubMed and Cochrane databases, to identify all peer-reviewed studies
performed on clopidogrel resistance in vascular and endovascular surgery. Studies
written in the English language from inception to 2022 were included. Case reports,
studies with limited information, nonhuman studies, and studies not pertaining to
vascular or endovascular surgery were excluded from analysis. Each study was independently
reviewed by 2 qualified researchers to assess eligibility.
Results
Of the 691 studies identified through the MeSH strategy, 16 studies met the inclusion
criteria and were reviewed and summarized. These studies focused on extracranial cerebrovascular
disease (n = 5) and peripheral arterial disease (PAD, n = 11), encompassing a total of 1,716 patients. The prevalence of clopidogrel resistance
ranged from 0% to 83.3%, depending on the diagnostic assay and cutoff values used.
In cerebrovascular disease, clopidogrel resistance may be associated with cerebral
embolization, ischemic neurologic events, and vascular-related mortality. In PAD,
clopidogrel resistance has been linked to recurrent stent thrombosis, target lesion
revascularization, amputation-free survival, and all-cause mortality.
Conclusions
This systematic review provides an up-to-date summary of clopidogrel resistance in
vascular and endovascular surgery. The impact of clopidogrel resistance remains incompletely
investigated, and future studies are needed to clarify the role of resistance testing
in patients with vascular disease.
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Article info
Publication history
Published online: December 17, 2022
Accepted:
December 7,
2022
Received:
August 18,
2022
Footnotes
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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