Randomized Comparisons of Double-Dose Clopidogrel or Adjunctive Cilostazol Versus Standard Dual Antiplatelet in Patients With High Posttreatment Platelet Reactivity

Tang, Yi‐Da; Wang, Wenyao; Yang, Min; Zhang, Kuo; Chen, Jing; Qiao, Shubin; Yan, Hongbing; Wu, Yongjian; Xiao-hong, Huang; Xu, Bo; Gao, Runlin; Yang, Yuejin; Yuan, Xun; Ji, Hongwen; Zhou, Zhou; Liu, Zhaohui; Chen, Jue; Yuan, Jinqing; Li, Haibo; Qian, Jie; Hu, Fenghuan; Shao, Chunli; Zhao, Hanjun; Hua, Yihong; Lü, Jie

doi:10.1161/circulationaha.117.030190

Cited by 75 publications

(60 citation statements)

References 45 publications

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“…In the ISAR‐HPR registry, retreatment with clopidogrel, switch to prasugrel, and reassessment of platelet function were associated with a significant decrease in the incidence of adverse events when compared to historical controls . The CREATIVE randomized study indicated that the intensified antiplatelet strategy with adjunctive use of cilostazol significantly improved clinical outcomes of patients with low response to clopidogrel . In the current study, patients with HPR to clopidogrel were randomized to receive ticagrelor or to continue on clopidogrel.…”

Section: Discussionmentioning

confidence: 94%

“…For HPR patients, a personalized antiplatelet treatment with selective intensification of P2Y12 receptor inhibition has been investigated in several previous studies . In the ISAR‐HPR registry, retreatment with clopidogrel, switch to prasugrel, and reassessment of platelet function were associated with a significant decrease in the incidence of adverse events when compared to historical controls .…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, several studies have focused on platelet function testing (PFT)‐guided antiplatelet therapy . However, PFT‐ or genotype‐guided antiplatelet therapy is not recommended by current guidelines, given the uncertainty of this precision medical approach in improving clinical outcomes .…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, several studies have focused on platelet function testing (PFT)-guided antiplatelet therapy. [7][8][9][10][11][12] However, PFT-or genotype-guided antiplatelet therapy is not recommended by current guidelines, given the uncertainty of this precision medical approach in improving clinical outcomes. [13][14][15][16] Compared to genotyping, the PFT is more cost-effective in determining responses to antiplatelet therapy.…”

mentioning

confidence: 99%

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Platelet function testing guided antiplatelet therapy reduces cardiovascular events in Chinese patients with ST‐segment elevation myocardial infarction undergoing percutaneous coronary intervention: The PATROL study

You

Guo

et al. 2020

Cathet Cardio Intervent

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Background Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor has become the standard of care to reduce thrombotic events in patients with acute coronary syndrome or after percutaneous coronary intervention (PCI). The role of routine platelet function testing (PFT) in patients treated with DAPT after PCI remains controversial and evidence of PFT‐guided antiplatelet therapy for patients with ST‐segment elevation myocardial infarction (STEMI) undergoing primary PCI is limited. Methods We analyzed 1,353 consecutive STEMI patients undergoing primary PCI. PFT was performed 72 hr postprocedure using a vasodilator‐stimulated phosphoprotein assay. The primary endpoint of major adverse cardio‐cerebral events (MACCEs) was defined as a composite of all‐cause death, cardiac death, nonfatal myocardial infarction, target vessel revascularization, and ischemic stroke. Patients with high platelet reactivity (HPR) were randomized to receive an intensified antiplatelet strategy by switching from clopidogrel to ticagrelor (HPR switch group) or to continue on clopidogrel (HPR nonswitch group). One‐year clinical outcomes were compared among the groups. Results The baseline clinical characteristics were comparable across all groups (all p > .05). At the 1‐year clinical follow‐up, the primary endpoint of MACCE was significantly higher in the HPR nonswitch group than in the non‐HPR and HPR switch groups (19.49% vs. 10.20% or 8.57%, p < .05), which was mainly caused by higher mortality (14.87% vs. 4.51% or 5.71%, p < .05). Major bleeding events were comparable across the groups. Conclusions In STEMI patients with HPR, identified by vasodilator stimulated phosphoprotein (VASP)‐determined PFT, switching clopidogrel to ticagrelor could significantly improve 1‐year clinical outcomes without increasing the risk of bleeding.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Platelet function testing guided antiplatelet therapy reduces cardiovascular events in Chinese patients with ST‐segment elevation myocardial infarction undergoing percutaneous coronary intervention: The PATROL study

You

Guo

et al. 2020

Cathet Cardio Intervent

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“…Results of the Clopidogrel Response Evaluation and AnTi-platelet InterVEntion in High Thrombotic Risk PCI Patients (CREATIVE) Trial which compared DDC with that of the standard DAPT or cilostazol associated TAPT showed the latter to significantly improved outcomes [14]. However, no significant difference was observed when DDC was compared to the standard DAPT.…”

Section: Discussionmentioning

confidence: 99%

Adverse clinical outcomes associated with double dose clopidogrel compared to the other antiplatelet regimens in patients with coronary artery disease: a systematic review and meta-analysis

Zhuo

Ouyang

et al. 2018

BMC Pharmacol Toxicol

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BackgroundRecently, several newer antiplatelet treatment strategies have been used in patients with coronary artery disease (CAD). Apart from the dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel, double dose clopidogrel (DDC), triple antiplatelet therapy (TAPT) consisting of aspirin, clopidogrel and cilostazol and other newer antiplatelet agents have shown to be effective in different ways. In this analysis, we aimed to systematically compare the adverse clinical outcomes and the bleeding events which were observed when DDC was compared to the other antiplatelet regimens in patients with CAD.MethodsEnglish publications comparing DDC with other antiplatelet regimens were searched from MEDLARS/MEDLINE, EMBASE, www.ClinicalTrials.gov and Google Scholar. Adverse cardiovascular outcomes and bleeding events were the study endpoints. Statistical analysis was carried out by the RevMan 5.3 software whereby odds ratios (OR) with 95% confidence intervals (CIs) were calculated.ResultsA total number of 23,065 participants were included. Results of this analysis showed major adverse cardiac events (MACEs), all-cause mortality, cardiac death, stroke, stent thrombosis, revascularization and myocardial infarction (MI) to have been similarly manifested in patients who were treated with DDC versus the control group with OR: 0.98, 95% CI: 0.78–1.22; p = 0.83, OR: 0.95, 95% CI: 0.77–1.17; p = 0.62, OR: 0.97, 95% CI: 0.79–1.20; p = 0.81, OR: 0.98, 95% CI: 0.65–1.48; p = 0.94, OR: 0.84, 95% CI: 0.40–1.75; p = 0.64, OR: 0.88, 95% CI: 0.52–1.49; p = 0.63, and OR: 0.89, 95% CI: 0.65–1.21; p = 0.45 respectively. Any minor and major bleedings were also similarly manifested.When DDC was compared to DAPT, no significant difference was observed in any bleeding event with OR: 1.58, 95% CI: 0.86–2.91; p = 0.14. Even when DDC was compared with either ticagrelor or prasugrel or TAPT, still no significant difference was observed in terms of bleeding outcomes.ConclusionsIn patients with CAD, adverse clinical outcomes were not significantly different when DDC was compared to the other antiplatelet regimens. In addition, bleeding events were also similarly manifested when DDC was compared to DAPT, TAPT or ticagrelor/prasugrel.

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Triple Antiplatelet Therapy and Combinations with Oral Anticoagulants after Percutaneous Coronary Intervention

Rowland¹,

Batty²,

Mehran³

et al. 2022

Interventional Cardiology

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Randomized Comparisons of Double-Dose Clopidogrel or Adjunctive Cilostazol Versus Standard Dual Antiplatelet in Patients With High Posttreatment Platelet Reactivity

Abstract: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01779401.

Cited by 75 publications

References 45 publications

Platelet function testing guided antiplatelet therapy reduces cardiovascular events in Chinese patients with ST‐segment elevation myocardial infarction undergoing percutaneous coronary intervention: The PATROL study

Platelet function testing guided antiplatelet therapy reduces cardiovascular events in Chinese patients with ST‐segment elevation myocardial infarction undergoing percutaneous coronary intervention: The PATROL study

Adverse clinical outcomes associated with double dose clopidogrel compared to the other antiplatelet regimens in patients with coronary artery disease: a systematic review and meta-analysis

Triple Antiplatelet Therapy and Combinations with Oral Anticoagulants after Percutaneous Coronary Intervention

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