Authors: Dobri Hazarbasanov Vasil Velchev Bozhidar Finkov Arman Postadjian Emil Kostov Nizar Rifai Dániel Aradi
Publish Date: 2012/01/15
Volume: 34, Issue: 1, Pages: 85-90
Abstract
Multiple studies have shown a correlation between high ontreatment platelet reactivity HPR and ischemic complications after percutaneous coronary interventions PCI however the role of platelet reactivity testing in order to adjust clopidogrel dose is debated We sought to determine whether a strategy incorporating platelet reactivity testing with the Multiplate analyzer to tailor the dose of clopidogrel is superior to standard clopidogrel treatment after PCI Between May 2008 and June 2009 192 consecutive patients undergoing PCI were randomized to a tailored treatment strategy using the Multiplate analyzer or to uniform administration of 75 mg clopidogrel In the tailored group platelet function was assessed 24 h after clopidogrel loading and patients with HPR 46 U received an additional 600 mg loading dose and 150 mg clopidogrel thereafter for one month The primary endpoint was the composite of cardiac death myocardial infarction ischemic stroke or definite/probable stent thrombosis during six months In the tailored group a repeated loading dose of 600 mg clopidogrel significantly decreased platelet reactivity in patients with HPR 610 U IQR 525–715 vs 215 U 158–305 P 00001 that remained unchanged during the maintenance phase on 150 mg clopidogrel 250 U IQR 198–270 P = 020 The incidence of the primary endpoint was significantly higher in the standard clopidogrel group as compared to the Multiplatetailored arm 53 vs 0 P = 003 In parallel MACCEfree survival significantly improved in patients with Multiplatetailored therapy Kaplan–Meier logrank P = 002 Increasing the dose of clopidogrel according to the Multiplate assay may reduce ischemic complications in patients on clopidogrel after PCI
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