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A high maintenance dose increases the inhibitory response to clopidogrel in patients with high on-treatment residual platelet reactivity.
MedLine Citation:
PMID:  21546102     Owner:  NLM     Status:  Publisher    
BACKGROUND: Patients with high on-treatment residual adenosine diphosphate-inducible platelet reactivity (HRPR) despite clopidogrel therapy are at an increased risk for adverse events after coronary stenting. A higher maintenance dose of clopidogrel may increase the inhibitory response in these patients. METHODS: We randomly assigned 46 patients with HRPR in at least one of three platelet reactivity tests to 75mg vs. 150mg clopidogrel for 3months after angioplasty and stenting for cardiovascular disease. Platelet reactivity was assessed by the VerifyNow P2Y12 assay, the vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay, and multiple electrode aggregometry (MEA) 24h and 3months after the intervention. RESULTS: Baseline platelet reactivity data did not differ significantly between treatment groups (all p>0.2). At 3months, platelet reactivities by the VerifyNow P2Y12 assay, the VASP assay, and MEA were 262±74 P2Y12 reaction units (PRU), 59.5±21.3%, and 46±19aggregation units (AU) in the standard dose group vs. 190±78PRU, 36.1±16.8%, and 26±16AU in the high maintenance dose group (all p≤0.003). Further, HRPR was significantly less frequent in patients assigned to 150mg clopidogrel compared to patients receiving 75mg clopidogrel per day (33% vs. 87%; p<0.001). CONCLUSION: A high maintenance dose increases the antiplatelet effects of clopidogrel in patients with HRPR after angioplasty and stenting for cardiovascular disease. However, it needs to be shown that the higher dosage is associated with a beneficial clinical outcome in these patients.
Thomas Gremmel; Sabine Steiner; Daniela Seidinger; Renate Koppensteiner; Simon Panzer; Christoph W Kopp
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-3
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
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