الفهرس 
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Abstract
Objectives: The goal of this study was to identify factors associated with higher platelet aggregation following clopidogrel therapy in subjects with acute coronary syndrome (ACS).
Background: A heterogeneous platelet reactivity response to clopidogrel exists, and the clinical or biochemical predictors of suboptimal platelet inhibition with clopidogrel remain unclear.
Methods: This study was conducted on 62 subjects with ACS requiring treatment with clopidogrel (75 mg daily for 7 days or more). The subjects were divided into two equal groups, diabetic and non diabetic groups. Chrono-log Aggergometer Series 490 used to estimate platelet aggregation.
Results: Platelet aggregation (mean38.58 ± 18.6%) was observed in 62 subjects (age 56.13 ± 7.9 years; 66.1% men). Statistical analysis revealed increase platelet aggregation in patients with history of CAD, hypertension and body mass index (BMI) ≥kg/m2.
Positive correlations were found between platelet aggregation and the level of fasting blood sugar (P < 0.001), body weight (p= 0.023) and BMI % (P = 0.005). Diabetic patients demonstrated a trend to lower response to clopidogrel treatment with platelet aggregation (42.87 ± 18.54) compared to non diabetic patients (34.29 ± 17.93) but this did not reach a statistical significance (p = 0.069). No significant differences as regards platelet aggregation between patients with elevated plasma fibrinogen(≥375 mg/dl) and those with level lower than 375 mg/dl (39.1 ± 19.1 Vs. 36.8 ± 17.29, P=0.685).
By studying the diabetic group individually, the statistical analysis revealed that the diabetic patient response to clopidogrel did not change by presence or absence of multiple clinical factors. However, the presence of hypertension or BMI ≥25 kg/m2 in non diabetic patients inhibits the response to clopidogrel.
Conclusions: DM, hypertension, past history of CAD and BMI≥25 kg/m2 are associated with higher platelet aggregation following clopidogrel treatment in patients with ACS. Positive correlations were found between platelet aggregation and the level of fasting blood sugar, body weight and BMI in those patients. The diabetic patient’s response to clopidogrel did not change by presence or absence of multiple clinical factors.