Tailored Clopidogrel Loading Dose According to Platelet Reactivity Monitoring to Prevent Acute and Subacute Stent Thrombosis

被引:243
作者
Bonello, Laurent [1 ,4 ]
Camoin-Jau, Laurence [4 ]
Armero, Sebastien [1 ]
Com, Olivier [1 ]
Arques, Stephane [5 ]
Burignat-Bonello, Caroline [2 ]
Giacomoni, Marie-Paule [3 ]
Bonello, Roland [3 ]
Collet, Frederic [3 ]
Rossi, Philippe [3 ]
Barragan, Paul [6 ]
Dignat-George, Francoise [4 ]
Paganelli, Franck [1 ]
机构
[1] Hop Univ Nord, Fac Med, Dept Cardiol, Marseille, France
[2] Hop Univ Nord, Fac Med, Serv Sante Publ & Informat Med, Marseille, France
[3] Clin Clairval, Dept Medicochirurg Cardiol, Marseille, France
[4] INSERM, UMRS 608, Fac Pharm, Marseille, France
[5] Hop Aubagne, Serv Cardiol, Aubagne, France
[6] Clin Fleurs, Dept Cardiol, Ollioules, France
关键词
PERCUTANEOUS CORONARY INTERVENTION; VASODILATOR-STIMULATED PHOSPHOPROTEIN; ADVERSE CARDIOVASCULAR EVENTS; ORAL ANTIPLATELET THERAPY; MYOCARDIAL-INFARCTION; BARE-METAL; IMPLANTATION; PHOSPHORYLATION; MULTICENTER; RESISTANCE;
D O I
10.1016/j.amjcard.2008.08.048
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Stent thrombosis remains a significant pitfall of percutaneous coronary intervention (PCI). A recent trial observed that an adjusted loading dose (LD) of clopidogrel according to platelet monitoring decreases the rate of major adverse cardiovascular events after PCI. We investigated if such a strategy of a tailored clopidogrel LD according to platelet reactivity monitoring could decrease the rate of stent thrombosis. This multicenter prospective randomized study included 429 patients with a low clopidogrel response after a 600-mg LD undergoing-PCI. Patients were randomized to a control group (n = 214) and to a vasodilator-stimulated phosphoprotein (VASP)-guided group (n = 215). In the VASP-guided group, patients received up to 3 additional 600-mg LDs of clopidogrel to obtain a VASP index <50% before PCI. The primary end point was the rate of stent thrombosis at I month. Secondary end points were rates of major adverse cardiovascular events and bleeding. Patients in the 2 groups had a high body mass index and were often diabetic (control vs VASP-guided group 28 +/- 5.1. vs 27.9 +/- 4.7 kg/m(2), p = 0.8, and 39% vs 33%, p = 0.2, respectively). PCI was performed in most patients for acute coronary syndrome in the 2 groups (52.3% vs 50.7%, p = 0.8). Despite a 2,400-mg LD of clopidogrel, 8% of patients in the VASP-guided group remained low responders. The rate of stent thrombosis was significantly lower in the VASP-guided group (0.5% vs 4.2%, p <0.01). The rate of major adverse cardiovascular events was also higher in the control group (8.9% vs 0.5%, p <0.001). There was no difference in the rate of bleeding (2.8% vs 3.7%, p = 0.8). In conclusion, a-tailored clopidogrel LD according to platelet reactivity monitoring decreases the rate of early stent thrombosis after PCI without increasing bleeding. (C) 2009 Published by Elsevier Inc. (Am J Cardiol 2009;103:5-10)
引用
收藏
页码:5 / 10
页数:6
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