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Case Report
 
Stent thrombosis after switch from nongeneric to generic clopidogrel
George Stoupakis1, Louis Teichholz2
1MD, Associate Physician, Heart and Vascular Institute, Hackensack University Medical Center, Hackensack, New Jersey, USA.
2MD, co-Chairman, Heart and Vascular Institute, Hackensack University Medical Center, Hackensack, New Jersey, USA.

doi:10.5348/ijcri-2014-01-436-CR-9

Address correspondence to:
George Stoupakis
MD, 5 Summit Avenue, Suite 200
Hackensack, NJ 07601. Hackensack
New Jersey
USA. 07601
Phone: 011 1201-343-7001
Fax: 011 1201-343-7232
Email: gstoupakis@yahoo.com

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How to cite this article:
Stoupakis G, Teichholz L. Stent thrombosis after switch from nongeneric to generic clopidogrel. International Journal of Case Reports and Images 2014;5(1):41–44.


Abstract
Introduction: The U.S. Food and Drug Administration recently approved generic versions of clopidogrel bisulfate which should lower the cost and improve compliance in patients requiring dual antiplatelet therapy post stent placement. However, there is marked inter-individual variability in the metabolism and intestinal absorption of clopidogrel. The different binders and fillers used in the generic versions can possibly affect absorption and reduce the bioavailability of the drug.
Case Report: We report a case of very late stent thrombosis in a patient eight days after the switch to generic clopidogrel bisulfate from branded clopidogrel (Plavix). The patient had received a sirolimus drug eluting stent almost three years prior to presentation and was on chronic dual antiplatelet therapy. Subsequent to the event, she was found to be a poor metabolizer of clopidogrel.
Conclusion: Although in most cases the use of generic clopidogrel is efficacious and safe, certain individuals, such as poor metabolizers, might be susceptible to increased clinical events when switching. We suggest any suspected cases should be reported to Medwatch so the clinical relevance could be determined.

Keywords: Stent thrombosis, Antiplatelet therapy, Clopidogrel


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Author Contributions
George Stoupakis – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Louis Teichholz – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© George Stoupakis et al. 2014; This article is distributed the terms of Creative Commons attribution 3.0 License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)