Impaired bioavailability of clopidogrel in patients with a ST-segment elevation myocardial infarction

Recent data has indicated that interindividual variability of intestinal absorption is an important determinant of the wide response variability to clopidogrel. We hypothesised that the physiological state of STEMI influences the intestinal absorption of clopidogrel. To evaluate this, we determined the pharmacokinetic response to a high loading dose of clopidogrel and the absolute ADP induced change in aggregation from baseline in STEMI patients and healthy volunteers. We found a significantly impaired bioavailability in STEMI patients as compared to healthy volunteers and a strong correlation between the reduction in platelet aggregation and the maximal plasma concentration of the active metabolite of clopidogrel. Although large clinical trails have clearly demonstrated the effectiveness of clopidogrel in the setting of STEMI, this small observational study encourages further research based on clinical endpoints to define the optimal dosing of clopidogrel in STEMI patients. © 2008 Elsevier Ltd. All rights reserved.