| A randomized pilot trial for aggressive therapeutic approaches in aspirin-resistant patients undergoing percutaneous coronary intervention. | |
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MedLine Citation:
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PMID: 21183763 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: There is great variability among individual patients in platelet inhibition after aspirin intake. Aspirin resistance has been associated with a higher incidence of ischemic events after percutaneous coronary intervention (PCI). The optimal antiplatelet therapy in aspirin-resistant patients undergoing PCI is unknown. The objective of this study was to evaluate whether aggressive antiplatelet therapy would reduce ischemic events in aspirin-resistant patients after PCI. METHODS: A total of 330 patients undergoing PCI (with bivalirudin) were screened for aspirin responsiveness. The resulting 36 aspirin-resistant patients were randomized into two arms: 1) conventional strategy patients received 325 mg aspirin orally and a loading dose of 600 mg clopidogrel at the time of the procedure; and 2) aggressive strategy patients received similar amounts of aspirin and clopidogrel, with the addition of an intravenous glycoprotein IIb/IIIa inhibitor bolus intraprocedurally. The primary outcome was an elevation of cardiac enzymes within 24 hours post procedure. The secondary outcome was a composite of major adverse cardiac events including death, myocardial infarction, stent thrombosis and urgent revascularization, and bleeding up to 30 days. RESULTS: Primary outcome occurred in 22% of the conventional strategy group and 11% of the aggressive strategy group (p = 0.36). The secondary outcome was reached in 27.8% of the conventional group and 5.5% of the aggressive strategy group (p = 0.17), which is suggestive of a statistical trend toward more ischemic events with conventional therapy. Importantly, there were 2 cases of definite stent thrombosis in the conventional strategy group. CONCLUSION: In aspirin-resistant patients, aggressive antiplatelet therapy tended to show better outcomes after PCI, without an increase in bleeding. These findings need validation in a large, randomized study. |
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Authors:
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Fadi El-Atat; Kunal Sarkar; Visali Kodali; Rucha Karajgikar; Madhavi Jakkulla; Angelica Mares; Samin Sharma; Annapoorna Kini |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of invasive cardiology Volume: 23 ISSN: 1557-2501 ISO Abbreviation: J Invasive Cardiol Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2010-12-24 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8917477 Medline TA: J Invasive Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 9-13 Citation Subset: IM |
Affiliation:
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Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029, USA. |
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Comment In:
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J Invasive Cardiol. 2011 Jan;23(1):14
[PMID:
21183764
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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