Glycoprotein IIb/IIIa Inhibitors Improve Outcome After Coronary Stenting in Clopidogrel Nonresponders: A Prospective, Randomized Study

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• 作者：Thomas Cuisset ; MD^?/sup> ; ^&dagger ; ; ^{thomascuisset@voila.fr} ; Corinne Frere ; MD ; PhD^&dagger ; ; Jacques Quilici ; MD^?/sup> ; Pierre-Emmanuel Morange ; MD ; PhD^&dagger ; ; Jean-Philippe Mouret ; MD^?/sup> ; Laurent Bali ; MD^?/sup> ; Pierre-Julien Moro ; MD^?/sup> ; Marc Lambert ; MD^?/sup> ; Marie-Christine Alessi ; MD ; PhD^&dagger ; ; Jean Louis Bonnet ; MD^?/sup>
• 关键词：clopidogrel response ; coronary stenting ; glycoprotein IIb/IIIa antagonist
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2008
• 出版时间：December 2008
• 年：2008
• 卷：1
• 期：6
• 页码：649-653
• 全文大小：192 K

文摘

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Objectives

The aim of this study was to assess, in clopidogrel nonresponders undergoing elective percutaneous coronary intervention (PCI), the benefit of adjusted antiplatelet therapy with glycoprotein (GP) IIb/IIIa antagonist administration during PCI for 1-month clinical outcome.

Background

Numerous biological studies have reported interindividual variability in platelet response to clopidogrel with clinical relevance, and high post-treatment platelet reactivity (adenosine diphosphate-induced aggregation >70 % ) has been proposed to define nonresponse to clopidogrel. These nonresponders might benefit from tailored antiplatelet therapy.

Methods

One hundred forty-nine clopidogrel nonresponders referred for elective PCI were prospectively included and randomized to ¡°conventional group?(n = 75) or ¡°active group?with GP IIb/IIIa antagonist (n = 74). All patients received 250-mg aspirin and 600-mg clopidogrel before PCI and platelet testing.

Results

The rate of cardiovascular events at 1 month was significantly lower in the ¡°active group?than in the ¡°conventional group? 19 % (n = 14) versus 40 % (n = 30), p = 0.006, odds ratio: 2.8; 95 % confidence interval: 1.4 to 6.0. No patient in either group had post-procedural Thrombolysis In Myocardial Infarction major bleeding or required transfusions.

Conclusions

The present study suggested benefit of tailored antiplatelet therapy during elective PCI with GP IIb/IIIa antagonist for clopidogrel nonresponders without increased bleeding risk.