Comparison of Higher Clopidogrel Loading and Maintenance Dose to Standard Dose on Platelet Function and Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents

Abuzahra, Mohammed; Pillai, Manu; Caldera, Angel; Hartley, W. Bryan; González, Rosa María Álvarez; Bobek, Jaromir; Dokainish, Hisham; Lakkis, Nasser

doi:10.1016/j.amjcard.2008.03.073

Cited by 28 publications

(21 citation statements)

References 10 publications

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“…A total of 119 patients undergoing PCI were blindly randomized in a 2:1 fashion to receive clopidogrel loading 600 mg on the table immediately before PCI and 75 mg 2 times per day for 1 mo (high-dose group) vs standard dosing (300 mg loading and 75 mg/d; low-dose group) [110] . Platelet aggregation was measured using light transmission aggregometry at baseline, 4 h and 30 d. The composite of cardiovascular death, myocardial infarction and target vessel revascularization was studied at 30 d in addition to major and minor bleeding.…”

Section: Possible Treatment Of Clopidogrel Resistancementioning

confidence: 99%

Clinical importance of aspirin and clopidogrel resistance

Fehér

Fehér²,

Pusch³

et al. 2010

WJC

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Section: Possible Treatment Of Clopidogrel Resistancementioning

confidence: 99%

Clinical importance of aspirin and clopidogrel resistance

Fehér

Fehér²,

Pusch³

et al. 2010

WJC

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“…Several investigators reported that increasing the dose or adding antiplatelet agents resulted in stronger platelet inhibition without increasing the number of bleeding complications 8,10,19,20) . This seems slightly different from our major finding mentioned above.…”

Section: Discussionmentioning

confidence: 99%

Platelet Function Measured Using a Whole Blood Aggregometer Can Predict Bleeding Events

Sairaku¹,

Nakano

Eno³

et al. 2011

JAT

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Aim:We hypothesized that excessive suppression of platelet function due to antiplatelet therapy can increase the incidence of bleeding complications. The aim of the present study was to find whether we could predict bleeding events by measuring platelet function. Methods: We enrolled 743 subjects whose platelet function was measured using a whole blood aggregometer based on a screen filtration pressure method. Of these subjects, 551 (74.2%) were treated with some type of antiplatelet agent. The endpoints were bleeding or ischemic events requiring hospitalization or extension of hospital stay. We prospectively compared the platelet function of subjects with and without bleeding or ischemic events.

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“…The superior platelet inhibition with the 600-mg loading dose was repeatedly demonstrated in other pharmacodynamic studies and has correlated with superior clinical outcomes without increasing bleeding complications [36]. Clopidogrel nonresponsiveness also may be partially overcome by a higher maintenance dose (150 mg) [37][38][39]. Angiolillo et al [38] demonstrated that a 150-mg clopidogrel maintenance dose is associated with enhanced platelet inhibition compared with a 75-mg maintenance dose in patients with type 2 diabetes as well as in those undergoing elective coronary stenting.…”

Section: P2y 12 Receptor Inhibitorsmentioning

confidence: 93%

Selecting optimal antiplatelet therapy based on platelet function monitoring in patients with coronary artery disease

Gurbel

Tantry

2009

Curr Treat Options Cardio Med

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Results from pharmacodynamic and translational research studies assessing platelet reactivity have highlighted the limitations of current oral antiplatelet therapy. The data from translational research studies present strong arguments against the "one-size-fits-all" approach that has been used in large-scale clinical trials. At one end of the spectrum, selected patients with excessively low on-treatment platelet reactivity may have unnecessary bleeding, whereas patients with high platelet reactivity may experience ischemic events. Current evidence suggests that high on-treatment platelet reactivity will become a major risk factor determined as standard of care in patients with cardiovascular diseases. Future translational research holds the promise of identifying a therapeutic window for antiplatelet therapy based on objective measurement of platelet physiology. The main aim of this therapeutic window is to effectively attenuate ischemic events while avoiding bleeding risk with excessive platelet inhibition in selected patients with optimal antiplatelet therapeutic strategies involving current or novel antiplatelet agents. Preliminary findings suggest there may be thresholds predictive of adverse ischemic events. Ongoing studies such as GRAVITAS (Gauging Responsiveness With a VerifyNow Assay-Impact on Thrombosis and Safety) and the S.T.E.N.T. Thrombosis Study and future research will likely support the current concepts and lead to personalized treatment regimens that will optimize antiplatelet therapy.

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Comparison of Higher Clopidogrel Loading and Maintenance Dose to Standard Dose on Platelet Function and Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents

Cited by 28 publications

References 10 publications

Clinical importance of aspirin and clopidogrel resistance

Clinical importance of aspirin and clopidogrel resistance

Platelet Function Measured Using a Whole Blood Aggregometer Can Predict Bleeding Events

Selecting optimal antiplatelet therapy based on platelet function monitoring in patients with coronary artery disease

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