Graft Thrombosis after Revascularization Due to CYP2C19 Polymorphism and Clopidogrel Resistance: A Rare Case Report
Istiaq Ahmed
Department of Cardiac Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
Md. Mohashin Reza
Department of Cardiac Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
Tanvir Rahman
Department of Cardiac Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
C. M. Mosabber Rahman
Department of Cardiac Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
Kazi Al-Hosne Jamil
Department of Cardiac Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
Manjurul Hasan
Department of Vascular Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
Shoaeb Imtiaz Alam *
Department of Vascular Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
Mufrid Kashem
Department of Cardiac Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
*Author to whom correspondence should be addressed.
Abstract
Peripheral arterial disease (PAD) is one of the most common atherosclerotic disease dealt by vascular surgeons. Patients who suffer from critical lower extremity ischemia should also be revascularized as soon as possible. In order to lower the risk of ischemic events following surgery, patients with PAD usually receive short-term (3–6 months) dual antiplatelet medications including clopidogrel and aspirin following revascularization. There are only a few studies available regarding CYP2C19 polymorphisms on clopidogrel resistance (CR) in PAD patients following revascularization. In the present case, an elderly diabetic hypertensive male was admitted to the Cardiovascular Surgery department of Dhaka Medical College and Hospital with the diagnosis of chronic right lower limb Ischemia due to distal femoral artery stenotic disease. He subsequently underwent revascularization by dacron vascular graft and received 6 months of aspirin and clopidogrel with rivaroxaban to prevent post-operative graft thrombosis. But after stopping rivaroxaban, he developed graft thrombosis due to genetic polymorphism of the CYP2C19 gene resulting clopidogrel resistance. He then received 3 cycles of prostaglandin therapy with aspirin and rivaroxaban and his symptoms were reduced gradually.
Keywords: graft thrombosis, CYP2C19 polymorphism, clopidogrel resistance