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The effect of clopidogrel besylate and clopidogrel hydrogensulfate on platelet aggregation in patients with coronary artery disease: a retrospective study
Authors:Borsiczky Balazs  Sarszegi Zsolt  Konyi Attila  Szabados Sandor  Gaszner Balazs
Affiliation:
  • a Department of Surgical Research and Techniques, Medical School, University of Pecs, 7624 Pécs Kodály Zoltán Str. 20., Hungary
  • b Heart Institute, Medical School, University of Pecs, 7624 Pécs, Ifjúság Str. 13., Hungary
  • Abstract:

    Background

    Recently several alternative forms of the original clopidogrel hydrogensulfate (CHS) were spread worldwide. A large amount of such drugs turned out to be clopidogrel besylate (CB). Only three studies, involving healthy volunteers, investigated the antiplatelet effect of CB, whereas its attribute remained unexplored in the case of patients with cardiovascular diseases. This retrospective study aimed to evaluate the difference between the antiplatelet effects of two clopidogrel formulas, CHS and CB, on patients with coronary artery diseases.

    Methods

    Data of 150 patients with previous CHS treatment were investigated. According to the documentations, the CHS therapy was shifted to CB. 94 patients of the selected population received dual antiplatelet therapy, clopidogrel and aspirin. The antiplatelet effects of CHS and CB were compared by ADP induced platelet aggregation measurements using light transmission aggregometry.

    Results

    Irrespective of the therapeutic combinations the performed statistical investigations failed to show significant difference (p = 0.30) between the effect of CB (AGGmaxCB: 27.6 ± 13.7%) or CHS (AGGmaxCHS: 29.0 ± 15.3%) on the ADP induced platelet aggregation. Insignificant deviations were found in both forms of clopidogrel salts, either in the lack (AGGmaxCB : 32.5 ± 14,2%; AGGmaxCHS: 34,0 ± 16,1%; p = 0,29) or in the presence of aspirin (AGGmaxCB: 24.7 ± 12,5%; AGGmaxCHS: 26,0 ± 14,1%; p = 0,31).

    Conclusion

    Our results indicated that both CB and CHS had an identical inhibitory effect on ADP induced platelet aggregation in patients with cardiovascular diseases. Moreover their efficiency showed no overall significant difference in the case of dual antiplatelet therapy with aspirin as well. However there might be an inter- and intraindividual variability between the two clopidogrel formulas.
    Keywords:ACE-I, Angiotensin-converting enzyme inhibitors   ADP, Adenosine diphosphate   ARB, Angiotensin receptor blocking agents   BB, Beta adrenergic receptor blocking agents   CB, clopidogrel besylate   CCB, calcium channel blocker   CHS, clopidogrel hydrogensulfate   DBP, diastolic blood pressure   HPR, highy platelet reactivity   HR, heart rate   LTA, Light transmission aggregometry   NSTEMI, Non-ST elevation myocardial infarction   PCI, Percutaneous coronary intervention   PPI, proton pump inhibitor   PPP, platelet-poor plasma   PRP, platelet-rich plasma   SBP, systolic blood pressure   STEMI, ST Elevation myocardial infarction   VASP, vasodilator stimulated phosphoprotein
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