Coronary artery diseaseTailored Clopidogrel Loading Dose According to Platelet Reactivity Monitoring to Prevent Acute and Subacute Stent Thrombosis
Section snippets
Methods
A multicenter, prospective, randomized study was performed. The study protocol was in accordance with the Declaration of Helsinki and approved by the local ethics committee of our institutions. All patients gave written informed consent before inclusion. Patients undergoing PCI for refractory angina pectoris under optimal medical therapy, silent ischemia on thallium scintigraphy, or non–ST-elevation acute coronary syndrome were eligible for inclusion. Exclusion criteria were persistent
Results
From August 2007 to March 2008, 1,122 patients admitted to the participating cardiology centers were prospectively screened for inclusion (Figure 1). A cohort of 953 patients without exclusion criteria was considered eligible. Because 55% of those patients had a VASP index <50% after the first LD of clopidogrel and therefore were considered good responders, they were not included in the study. A total of 429 patients had a VASP index ≥50% and were included and randomized to the control group (n
Discussion
The present study suggests that a tailored clopidogrel LD according to platelet reactivity monitoring decreases the rate of stent thrombosis in patients undergoing PCI. Of importance, this strategy of clopidogrel LD adjustment was safe and not associated with increased bleeding.
This result is of clinical interest because stent thrombosis still occurs at a relatively high rate and is a major clinical concern because of its poor prognosis.8, 9, 10, 11 Further, the benefit of a tailored LD of
Acknowledgment
We thank the catheterization laboratory staff and nurses for their assistance. We also thank Probal Roy, MD, Gilles Lemesle for their helpful comments and Kathryn Coons, medical writer, for her great editorial assistance in the preparation of this report.
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