Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 43864

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : July | Volume : 15 | Issue : 7 | Page : FC06 - FC09 Full Version

Assessment of Clopidogrel Resistance in Post Myocardial Infarction Patients after 24 to 48 Hours of Initiation of Treatment: A Cross-sectional Study

Published: July 1, 2021 | DOI:
Mayukh Mukherjee, Suhrita Paul , Manasi Basu Banerjee , Sayanti Ghatak , Santanu Guha5 , Arnab Chattopadhyay

1. Assistant Professor, Department of Pharmacology, R. G. Kar Medical College, Kolkata, West Bengal, India. 2. Principal, Department of Pharmacology, Burdwan Medical College, Burdwan, West Bengal, India. 3. Professor, Department of Pharmacology, Medical College, Kolkata, West Bengal, India. 4. Junior Resident, Department of Physiology, Medical College, Kolkata, West Bengal, India. 5. Professor, Department of Cardiology, Medical College, Kolkata, West Bengal, India. 6. Associate Professor, Department of Haematology and Transfusion Medicine, Medical College, Kolkata, West Bengal, India.

Correspondence Address :
Dr. Mayukh Mukherjee,
28, Netaji Lane, Baidyabati, Hooghly, Kolkata-712222, West Bengal, India.


Introduction: Clopidogrel is an antiplatelet agent used to prevent platelet aggregation and further blockage of coronary arteries in Acute Coronary Syndrome (ACS) patients. Inadequate response to clopidogrel has been demonstrated in some patients that might lead to re-infarction even when receiving standard doses of clopidogrel.

Aim: To demonstrate the presence of resistance to standard oral doses of clopidogrel in a tertiary care hospital located in eastern India.

Materials and Methods: It was a descriptive cross-sectional study conducted from January 2015 to June 2016, in Medical College Kolkata, (previously known as Calcutta Medical College), India. Total 32 patients, previously not on any antiplatelet therapy, presenting with biomarker positive ACS were evaluated. The patients were given clopidogrel (300 mg) along with aspirin (325 mg) on presentation followed by clopidogrel (75 mg) and aspirin (75 mg) once daily. Blood samples were collected after 24-48 hours of administering the above mentioned doses orally. A 3.2% citrate was used as anti-coagulant. Platelet Rich Plasma (PRP) and Platelet Poor Plasma (PPP) were prepared from this blood samples by centrifugation. Platelet aggregation was studied by adding 10 μM Adenosine Diphosphate (ADP) in that PRP and it was compared with PPP in Light Transmittance Aggregometer (LTA). Platelet aggregation ≥50% in presence of 10 μM ADP was termed as Clopidogrel Resistance (CR). Differences between groups were assessed with Chi-square test and Fisher-exact test for categorical variables. The p-value of <0.05 was considered to be statistically significant.

Results: Mean age of the study participants was 60.7 years, and 23 (71.8%) out of 32 patients were male while 9 (28.2%) were female. Total 7 (21.8%) of the patients were found to be resistant to standard doses of clopidogrel. A 3 (60%) out of 5 patients with positive family history of Cardiovascular Diseases (CVD) showed CR (p-value=0.025). Incidences of CR was higher among women 3 (33.3%) and in patients receiving thrombolysis 4 (28.5%). Though these percentages were high but not statistically significant.

Conclusion: In this study, 21.8% ACS patients showed resistance to the antiplatelet effects of clopidogrel in the conventional dose. A long term prospective Randomised Controlled Trials (RCT) with larger sample size is required to give an insight into this problem.


Antiplatelet, Re-infarction, Stent-thrombosis

Clopidogrel is one of the most commonly used antiplatelet agents used in patients with ACS. Even after timely treatment with antiplatelet drugs many patients suffer from reinfarction (1). This has raised concern among the cardiologists throughout the world about a new phenomenon called antiplatelet resistance (2). The antiplatelet drugs, namely aspirin and clopidogrel, fail to prevent platelet aggregation despite administration of standard doses.

Clopidogrel is administered orally and only 50% of it is absorbed. It is a pro-drug and is partially converted into active metabolite by CYP2C19 enzyme in liver. It acts on P2Y12 receptor and irreversibly inhibits platelet function (3). But this antiplatelet action takes nearly four hours to start and develops over days. Moreover, due to genetic polymorphism, clopidogrel activation shows high inter individual variability (4). Sometimes, drugs like omeprazole which inhibit CYP2C19 may also be responsible for poor antiplatelet action of clopidogrel (5).

Some studies, done all over the world, showed varied presence of CR from 5-44% (6),(7). Studies done in India are few in number (6),(8). Ray S, found that CR is a problem here as well, but methods to identify it were not standardised and not freely available (6). Moreover, Kar R et al., showed that CR may be multifactorial but was not associated with single gene polymorphism (8). A large number of patients suffering from Acute Myocardial Infarction (AMI) are treated with clopidogrel and some of them develop adverse cardiovascular event like re-infarction or stent thrombosis within six months as a result of CR (7). The study was done to know the prevalence of CR among AMI patients and factors associated with it.

Material and Methods

It was a descriptive cross-sectional study conducted from January 2015 to June 2016, in Medical College Kolkata, (previously known as Calcutta Medical College), India. After obtaining Institutional Ethics Committee clearance (memo no. MC/KOL/IEC/NON-SPON/421/11-2014) 32 consenting patients were recruited in the study.

Inclusion criteria: Patients admitted with history of AMI or biomarker positive ACS in the last 24-48 hours were included in the study.

Exclusion criteria: Patients who were on Nonsteroidal Anti-inflammatory Drugs (NSAIDs) (other than Aspirin), receiving drugs like omeprazole which inhibit CYP2C19, had known personal or family history of bleeding diathesis or had platelet counts of <150×103/mL or >450×103/mL were excluded from the study.

On admission, patients were given 300 mg clopidogrel orally along with other medications. It was followed by oral dose of 75 mg clopidogrel/day. In this study, 32 patients, admitted in Intensive Coronary Care Unit (ICCU) following AMI, were recruited.

Collection of Blood Sample

After following proper aseptic technique, 21 gauge needles were used to draw blood from antecubital vein within 24-48 hours of initiation of treatment. Initial 3-4 mL of blood was used for other routine tests to avoid spontaneous activation of platelets. 3.2% citrate solution was used as anticoagulant while collecting blood.

Analysis of Platelet Function

Platelet-Rich Plasma (PRP) was prepared from this blood sample by centrifugation at 200 gm for 15 minutes. PPP, required for comparison in LTA, was prepared by centrifugation of blood at 1500 gm for 15 minutes. Platelet aggregation was studied by adding 10 μm ADP in that PRP and it was compared with PPP in LTA. Platelet aggregation ≥50% in presence of 10 μm ADP was termed as CR (9),(10).

Statistical Analysis

Windows Microsoft Excel 2010 was used for tabulation of data and statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software (version 22.0). Data were found to be normally distributed by using Kolmogorov-Smirnov test. Normally distributed continuous variables were presented as Mean±SD. Categorical variables were expressed as frequencies and percentages.


All recruited patients were ≥45 years of age and mean age was 60.7 years. Out of 32 recruited patients, 23 (71.8%) were male and 9 (28.2%) were female. The study revealed that 7 (21.8%) patients were clopidogrel-resistant; most of them belonged to 51-60 years age group. The (Table/Fig 1) shows that more females were resistant to clopidogrel 3 (33.3%) than males 4 (17.3%) (p-value=0.327).

Thirty (93.75%) patients presented with STEMI and all seven CR cases belonged to this group (p-value 0.44). CR was more common in patients treated by thrombolysis though, it was not statistically significant (p-value 0.419). No statistically significant association was found between pathological Q wave and CR (p-value=0.732).

Among 10 diabetic patients, 2 (20%) were clopidogrel-resistant; whereas in non diabetic group, 5 (22.73%) patients were clopidogrel-resistant (p-value=0.863). Patients having positive family history of CVD showed statistically significant association with CR (p-value 0.025). Three patients (60%) with family history of CVD showed CR. Those having no such history showed clopidogrel-resistance in 4 (14.81%) cases. Seven patients (23.33%) with no history of AMI showed CR.

A 3 (17.6%) out of 17 patients having history of angina showed CR. Only two patients had known history of dyslipidaemia. All 7 (23.33%) clopidogrel-resistant patients had no known history of dyslipidaemia (p-value=0.44). One (6.67%) hypertensive patient showed CR and in the non hypertensive group it was 6 (35.29%) (p-value=0.051).


All recruited patients were ≥45 years of age and mean age was 60.7 years. Out of 32 recruited patients, 23 (71.8%) were male and 9 (28.2%) were female. The study revealed that 7 (21.8%) patients were clopidogrel-resistant; most of them belonged to 51-60 years age group. The (Table/Fig 1) shows that more females were resistant to clopidogrel 3 (33.3%) than males 4 (17.3%) (p-value=0.327).

Thirty (93.75%) patients presented with STEMI and all seven CR cases belonged to this group (p-value 0.44). CR was more common in patients treated by thrombolysis though, it was not statistically significant (p-value 0.419). No statistically significant association was found between pathological Q wave and CR (p-value=0.732).

Among 10 diabetic patients, 2 (20%) were clopidogrel-resistant; whereas in non diabetic group, 5 (22.73%) patients were clopidogrel-resistant (p-value=0.863). Patients having positive family history of CVD showed statistically significant association with CR (p-value 0.025). Three patients (60%) with family history of CVD showed CR. Those having no such history showed clopidogrel-resistance in 4 (14.81%) cases. Seven patients (23.33%) with no history of AMI showed CR.

A 3 (17.6%) out of 17 patients having history of angina showed CR. Only two patients had known history of dyslipidaemia. All 7 (23.33%) clopidogrel-resistant patients had no known history of dyslipidaemia (p-value=0.44). One (6.67%) hypertensive patient showed CR and in the non hypertensive group it was 6 (35.29%) (p-value=0.051).


Clopidogrel resistance may be responsible for re-infarction in some patients presenting with ACS. The study found 21.86% patients to be Clopidogrel-resistant. Patients having positive family history for CVD were more likely to be clopidogrel-resistant. Further studies are required involving large number of patients in multiple centres to ascertain these findings.


Mendis S, Thygesen K, Kuulasmaa K, Giampaoli S, Mahonen M, Ngu Blackett K, et al. World Health Organization definition of myocardial infarction: 2008-09 revision. Int J Epidemiol. 2011;40(1):139-46. [crossref] [PubMed]
Marginean A, Banescu C, Scridon A, Dobreanu M. Anti-platelet therapy resistance- concept, mechanisms and platelet function tests in intensive care facilities. J Crit Care Med (Targu Mures). 2016;2(1):06-15. [crossref] [PubMed]
Wallentin L. P2Y(12) inhibitors: Differences in properties and mechanisms of action and potential consequences for clinical use. Eur Heart J. 2009;30(16):1964-77. [crossref] [PubMed]
Pan Y, Chen W, Xu Y, Yi X, Han Y, Yang Q, et al. Genetic polymorphisms and clopidogrel efficacy for acute ischemic stroke or transient ischemic attack: A systematic review and meta-analysis. Circulation. 2017;135(1):21-33. [crossref] [PubMed]
Norgard NB, Mathews KD, Wall GC. Drug-drug interaction between clopidogrel and the proton pump inhibitors. Ann Pharmacother. 2009;43(7):1266-74. [crossref] [PubMed]
Ray S. Clopidogrel resistance: The way forward. Indian Heart J. 2014;66(5):530-34. [crossref] [PubMed]
Gurbel PA, Tantry US. Clopidogrel resistance? Thromb Res. 2007;120(3):311-21. [crossref] [PubMed]
Kar R, Meena A, Yadav BK, Yadav R, Kar SS, Saxena R. Clopidogrel resistance in North Indian patients of coronary artery disease and lack of its association with platelet ADP receptors P2Y1 and P2Y12 gene polymorphisms. Platelets. 2013;24(4):297-302. [crossref] [PubMed]
Members WC, Smith SC, Feldman TE, Hirshfeld JW, Jacobs AK, Kern MJ, et al. ACC/AHA/SCAI 2005 Guideline update for percutaneous coronary intervention- summary article. Circulation. 2006;113(1):156-75. [crossref] [PubMed]
Angiolillo DJ, Shoemaker SB, Desai B, Yuan H, Charlton RK, Bernardo E, et al. Randomized comparison of a high Clopidogrel maintenance dose in patients with diabetes mellitus and coronary artery disease: Results of the Optimizing Antiplatelet Therapy in Diabetes Mellitus (OPTIMUS) study. Circulation. 2007;115(6):708-16. [crossref] [PubMed]
Barsky AA, Arora RR. Clopidogrel resistance: Myth or reality? J Cardiovasc Pharmacol Ther. 2006;11(1):47-53. [crossref] [PubMed]
Nguyen TA, Diodati JG, Pharand C. Resistance to clopidogrel: A review of the evidence. J Am Coll Cardiol. 2005;45(8):1157-64. [crossref] [PubMed]
Guha S, Mookerjee S, Guha P, Sardar P, Deb S, Roy PD, et al. Antiplatelet drug resistance in patients with recurrent acute coronary syndrome undergoing conservative management. Indian Heart J. 2009;61(4):348-52.
Guha S, Sardar P, Guha P, Roy S, Mookerjee S, Chakrabarti P, et al. Dual antiplatelet drug resistance in patients with acute coronary syndrome. Indian Heart J. 2009;61(1):68-73.
Kumar S, Saran RK, Puri A, Gupta N, Sethi R, Surin WR, et al. Profile and prevalence of clopidogrel resistance in patients of acute coronary syndrome. Indian Heart J. 2007;59(2):152-56.
Shaya FT, Gu A, Yan X. Effect of persistence with drug therapy on the risk of myocardial re-infarction. P T. 2008;33(5):288-95.
Ahumada M, Cabadés A, Valencia J, Cebrián J, Payá E, Morillas P, et al. Investigadores del registro PRIMVAC. El reinfarto como complicación del infarto agudo de miocardio. Datos del registro PRIMVAC [Reinfarction as a complication of acute myocardial infarction. PRIMVAC Registry data]. Rev Esp Cardiol. 2005;58(1):13-19. Spanish. [crossref] [PubMed]
McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med. 2011;124(1):40-47. [crossref] [PubMed]
Rasmanis G, Vesterqvist O, Gréen K, Edhag O, Henriksson P. Evidence of increased platelet activation after thrombolysis in patients with acute myocardial infarction. Br Heart J. 1992;68(4):374-76. [crossref] [PubMed]
Paul R, Banerjee AK, Guha S, Chaudhuri U, Ghosh S, Mondal J, et al. Study of platelet aggregation in acute coronary syndrome with special reference to metabolic syndrome. Int J App Basic Med Res. 2013;3:117-21. [crossref] [PubMed]
Su JF, Hu XH, Li CY. Risk factors for clopidogrel resistance in patients with ischemic cerebral infarction and the correlation with ABCB1 gene rs1045642 polymorphism. Exp Ther Med. 2015;9(1):267-71. [crossref] [PubMed]
Wallentin L, James S, Storey RF, Armstrong M, Barratt BJ, Horrow J, et al. PLATO investigators. Effect of CYP2C19 and ABCB1 single nucleotide polymorphisms on outcomes of treatment with ticagrelor versus clopidogrel for acute coronary syndromes: A genetic substudy of the PLATO trial. Lancet. 2010;376(9749):1320-28. [crossref]
Idrissi H, Hmimech W, Khorb NE, Akoudad H, Habbal R, Nadifi S. A synergic effect between CYP2C19*2, CYP2C19*3 loss-of-function and CYP2C19*17 gain-of-function alleles is associated with Clopidogrel resistance among Moroccan Acute Coronary Syndromes patients. BMC Res Notes. 2018;11(1):46. Doi: 10.1186/s13104-018-3132-0. PMID: 29347970; PMCID: PMC5774088. [crossref] [PubMed]
Schieffer B, Bünte C, Witte J, Hoeper K, Böger RH, Schwedhelm E, Drexler H. Comparative effects of AT1-antagonism and angiotensin-converting enzyme inhibition on markers of inflammation and platelet aggregation in patients with coronary artery disease. J Am Coll Cardiol. 2004;44(2):362-68. Doi: 10.1016/j.jacc.2004.03.065. PMID: 15261932. [crossref] [PubMed]
Gomi T, Ikeda T, Shibuya Y, Nagao R. Effects of antihypertensive treatment on platelet function in essential hypertension. Hypertens Res. 2000;23(6):567-72. Doi: 10.1291/hypres.23.567. PMID: 11131267. [crossref] [PubMed]
Su J, Li X, Yu Q, Liu Y, Wang Y, Song H, et al. Association of P2Y12 gene promoter DNA methylation with the risk of clopidogrel resistance in coronary artery disease patients. Biomed Res Int. 2014;2014:450814-14. [crossref] [PubMed]
Hung J, Lam JY, Lacoste L, Letchacovski G. Cigarette smoking acutely increases platelet thrombus formation in patients with coronary artery disease taking aspirin. Circulation. 1995;92(9):2432-36. Doi: 10.1161/01.cir.92.9.2432. PMID: 7586342. [crossref] [PubMed]
Desai NR, Mega JL, Jiang S, Cannon CP, Sabatine MS. Interaction between cigarette smoking and clinical benefit of clopidogrel. J Am Coll Cardiol. 2009;53(15):1273-78. [crossref] [PubMed]
Ma TK, Lam YY, Tan VP, Yan BP. Variability in response to clopidogrel: How important are pharmacogenetics and drug interactions? Br J Clin Pharmacol. 2011;72(4):697-706. [crossref] [PubMed]

DOI and Others


Date of Submission: Mar 06, 2021
Date of Peer Review: Apr 27, 2021
Date of Acceptance: Jun 02, 2021
Date of Publishing: Jul 01, 2021

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Mar 09, 2021
• Manual Googling: Jun 01 2021
• iThenticate Software: Jun 22, 2021 (8%)

Etymology: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)