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

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. .