Clopidogrel Appropriate for PCI in Liver Transplant Candidates

By Reuters Staff

January 08, 2020

NEW YORK (Reuters Health) - In patients with decompensated cirrhosis undergoing percutaneous coronary intervention (PCI), clopidogrel safely inhibits platelet aggregation, according to a small study of liver-transplant candidates.

"Patients with advanced liver failure are often referred to a cardiologist to evaluate whether their cardiac function could withstand a liver-transplant surgery; however, there is very limited evidence about how best to treat patients in this scenario," said Dr. Cory R. Trankle of Virginia Commonwealth University in Richmond.

In particular, he told Reuters Health by email, "if the patients require a stent in their coronary artery . . . it is unclear whether the liver is able to activate certain medications in order to prevent that stent from thrombosing - which could have devastating consequences."

Dr. Trankle and colleagues studied 11 such patients with a median age of 63 years. Exclusion criteria included antiplatelet or anticoagulant medications other than aspirin and known coagulation abnormality unrelated to cirrhosis.

The patients received PCI and a clopidogrel loading dose of 600 mg orally, followed by maintenance therapy with aspirin 81 mg and clopidogrel 75 mg daily.

The median value of platelet reactivity units significantly decreased from baseline at all time points following clopidogrel load, with most patients responding two hours after the dose, the team reports in JACC: Cardiovascular Interventions.

Over the course of monitoring, there were no bleeding events, stent thrombosis, or acute coronary events during the period of dual antiplatelet therapy.

"Our study tested patients in this setting with a variety of sophisticated platelet assays and found that indeed the medication clopidogrel is working as it should," concluded Dr. Trankle.

"Further studies," he added, "are needed to determine the best strategy for cardiologists in seeing these types of patients, as the prevalence of certain forms of liver failure continues to rise."

SOURCE: JACC: Cardiovascular Interventions, online December 25, 2019