A Case of Postoperative F-P Bypass Thrombotic Occlusion which was Estimated to be for Genetically Defined Poor Metabolizer of Clopidogrel

Abstract

Peripheral artery disease (PAD) has been treated in Japan following the TASC II guidelines. Antiplatelet drugs as adjuvant pharmacotherapy after revascularization has been recommended, and they should be started preoperatively or just after the surgery, to prevent the thrombotic occlusion at the treated site. About 20% of the Japanese population are considered to be the poor metabolizer of clopidogrel, but measuring the platelet function for investigating the effect of the drug is not generally accepted yet. A 60-year-old man underwent the Lt. Femoro — Popliteal above the knee bypass 20 months ago, however, his bypass graft was occluded for the local thrombosis. His platelet aggregation measured by VerifyNow PRU was 209, and % inhibition was 0% even though the patient had been taking clopidgrel regularly. Genotype investigation revealed that his CYP2C19 genotype was *2/*2, the poor metabolizer of clopidogrel. In the treatment of the PAD, point of care of the platelet function is important to prevent bleeding and the thrombotic complications during antiplatelet therapy.