A Double-Blind, Randomized Study on Prevention and Existence of a Rebound Phenomenon of Platelets After Cessation of Clopidogrel Treatment

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• 作者：Dirk Sibbing ; Julia Stegherr ; Siegmund Braun ; Julinda Mehilli ; Stefanie Schulz ; Melchior Seyfarth ; Adnan Kastrati ; Nicolas von Beckerath ; Albert Schö ; mig
• 关键词：clopidogrel ; platelet aggregation ; platelet rebound
• 刊名：Journal of the American College of Cardiology
• 出版年：2010
• 出版时间：9 February 2010
• 年：2010
• 卷：55
• 期：6
• 页码：558-565
• 全文大小：283 K

文摘

<h4 class=""h4"">Objectivesh4>The goal of this study was to assess whether a platelet rebound exists and whether it can be attenuated by clopidogrel tapering.<h4 class=""h4"">Backgroundh4>

Clinical studies have reported a clustering of thrombotic events after stopping clopidogrel treatment. The hypothesis of a rebound phenomenon of platelets has been declared causative, but its existence has never been confirmed. Tapering of clopidogrel over a certain period of time before stopping the drug completely might provide a way to attenuate this supposed phenomenon.<h4 class=""h4"">Methodsh4>

Patients (n = 69) receiving clopidogrel treatment due to prior drug-eluting stent placement and planning to stop clopidogrel were recruited in a double-blind, randomized trial. Patients were randomized to either receive a pre-specified tapering regimen (tapering group; n = 35) for 4 weeks with complete discontinuation of clopidogrel thereafter or continue a daily clopidogrel intake for 4 more weeks with abrupt discontinuation afterwards (off group; n = 34). Platelet aggregation (PA) was assessed with light transmission aggregometry (LTA) and multiple electrode aggregometry (MEA) simultaneously at study inclusion and at weeks 2 to 8 after randomization. The primary end point was the highest value of adenosine diphosphate–induced PA measured with LTA in the weeks after complete cessation of clopidogrel in both groups.<h4 class=""h4"">Resultsh4>

The highest values of adenosine diphosphate–induced PA after complete cessation of clopidogrel were similar between both groups (p = 0.21 with LTA, and p = 0.55 with MEA).<h4 class=""h4"">Conclusionsh4>

Tapering of clopidogrel does not result in lower PA values after clopidogrel withdrawal. The course of PA values after clopidogrel cessation provides no evidence for the existence of a rebound phenomenon of platelets.